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Clarian Health, Others Will Dock Your Paycheck If You're Fat

Anyone who claims fat people aren't discriminated against now has less sure footing to stand on. Clarian Health, a healthcare system based in Indianapolis, Indiana, has stated that it's going to take $10 out of every fat person's paycheck starting in 2009.

If your BMI is over 30, it's going to cost you $10 per paycheck. This is not a joke. This is legal. This is bullshit.

In addition, the Yahoo article notes that there are a couple of other companies doing this right now:

While Clarian's plan is highly unusual, a few other employers are using the stick approach, too. Western & Southern Financial Group, a Cincinnati-based insurance and financial-services provider, has been issuing employees with high BMIs a surcharge to their premiums since 2001. Depending on their scores, employees are charged a tiered fee of between $15 and $75 a month if their self-reported BMI is high, but can have those fees refunded if their numbers go down.

Preventure, a provider of fitness and wellness programs for midsize to large employers, has one client in the manufacturing industry that rewards employees when their BMI falls from their baseline score and charges them more when their number rises. "We haven't seen a lot of companies do it," says Laura Gilligan, director of business development for Preventure, "but I sense it might be a trend."

Is this what will finally mobilize us? The fact that these companies are coming after our paychecks? [Thanks for the tip, ceilidh!]

LiveJournal's Pro-Anorexia Groups | Oh, I guess our work is done.

BabySeal August 9th, 2007 | Link | "employees are charged a

"employees are charged a tiered fee of between $15 and $75 a month if their self-reported BMI is high, but can have those fees refunded if their numbers go down. "

Am I getting it correctly that, for this "tiered" system to be applied, people must report their weight/BMI to their employer? And is requesting the disclosure of medical data (because that's what weiight is) legal?

jmars August 9th, 2007 | Link | I suspet, BabySeal, that if

I suspet, BabySeal, that if you don't agree with the "request" to self-report, you will be charged some fee for failing to comply.

The thing I found most illuminating about this story was the statement that the company is expecting that more employees will be "docked" for having a BMI over 30 than will be docked for having high blood pressure, cholesterol or blood sugar ($5 each per check for any of these conditions).

So, let me get this straight: we all KNOW that fat people are unhealthy and we all have out-of-control high blood pressure and cholesterol and diabetes, right? Then why is it that they are expecting fewer people to actually have those problems than are fat? Shouldn't all the fat people have actual health conditions that justify charging the extra money?

Are we going to start charging pre-menopausal women more because they might get pregnant? Women more in general because they are more likely to get breast cancer? Employees who report working 70+ hours a week more because the stress might cause them to have HBP and other conditions? Asians, Hispanics and blacks more becaue they are more likely to develop diabetes? Where does it end?

This says two things to me:

1. The first thing we've got to do is break down the knee-jerk "all fat people are unhealthy" nonsense. It's too easy for people to justify discrimination based on the misleading representation in the media about the health status of most fat people. Have any of you ever seen an article that actually talks about the rate of Type II diabetes (TTD) among fat people? I haven't. All I've seen are statistics like "people with a BMI over 40 are 63 times more likely to have TTD than a person with a "normal" BMI." But what exactly does this mean? If one in 1,000 people with a normal BMI has TTD, that means that 63 in 1,000 people with a BMI over 40 -- or about 7 in 100 -- actually have the illness. But 7 in 100 is a lot less scary sounding than "63 times." The health impact of weight has been overhyped and mischaracterized and it's got to stop. I'd personally start by demanding that the AMA disassociate itself, and require its members to disassociate themselves, from any weight loss programs and that it revise its statements on weight to reflect the reality that diets don't work, that weight in and of itself is not a measure of health and that HAES recommendations should be given to ALL patients (not just fat ones) instead of vague instructions to "lose 20, 50, 100 pounds."

2. The healthcare system in the US is totally broken and our only hope is to adopt a universal care model under which all US citizens -- regardless of health, age, employment, etc. -- will have access to care. There's no reason that adopting such a system needs to cost any more money. But I grow more and more convinced that it's just unfair to ask employers to shoulder so much of the cost of providing health care and that connecting access to health insurance (and thus health care) to employment doesn't work.

Sorry this is so long, but it just infuriates me that the cost of our broken health care system is increasingly being foisted on fat people.

cpeter3644 February 20th, 2009 | Link | Good points jmars and thanks

Good points jmars and thanks for crunching the numbers.
I agree that our system needs fixing and the healthcares system is merely a reflection of a much greater problem of corporate greed. I'm always amazed how easily people believe the argument that fat people are the reason insurance premiums are so high and NOT the fact that insurance companies and every other company's sole focus is to maixmize profits. The only way this Goliath will listen is via the wallet. While changing the hearts and minds of the masses is noble, it will take decades to do so. What Americans respond most to is litigation. Our movement needs to attract bright, gifted and passionate lawyers (yes I groaned too when thinking it) that will take on corporations where they will listen the most.

jportnick's picture
jportnick
August 9th, 2007 | Link | This really is scary. In

This really is scary. In fact it's one of tne of the most appalling developments I've seen in several years. Aside from the fact this practice is blatantly discriminatory (I dare them to show up in San Francisco with these standards) it is plainly punative and instituted solely to punish people who are fat.

And let's not even consider the fact that this employer, like everyone else, has no safe, effective, long term way to make people thin, and dieting over time reliably produces the result of weight gain. What are they going to do when people of all sizes start gaining weight due to their habit of denying themselves sufficient fuel? Chop their heads off in the town square?

Sheez.

Jennifer Portnick
Personal Trainer (who is fat)
San Francisco, CA

wriggle99 August 9th, 2007 | Link | Boycott

Boycott any company that forces this on their employees. Sticking out tongue

DeeLeigh's picture
DeeLeigh
August 9th, 2007 | Link | That's an excellent idea.

That's an excellent idea. We should maintain a list.

TariRocks's picture
TariRocks
August 9th, 2007 | Link | Grrrr.

This is infuriating, that's for sure. My company hasn't started this kind of thing, but they are constantly bombarding us with weight loss tips and invitations to join monitored weight loss programs - and if we do, they make contributions to health care accounts we can use to cover health expenses (including massages, which is almost tempting enough to make me join for the heck of it). They have done this sort of charge for smokers, though...which tells me something this fascist could be coming down the pike someday.

richie79's picture
richie79
August 9th, 2007 | Link | Aside from the fact this

Aside from the fact this practice is blatantly discriminatory (I dare them to show up in San Francisco with these standards) it is plainly punative and instituted solely to punish people who are fat.

Absolutely. Whilst I disagree with charging anyone, fat or thin, extra for pre-existing conditions (it's not as though they bloody asked for diabetes or whatever) ther is nevertheless a legal precedent of variable rates according to risk - indeed the entire insurance industry is based on lower premiums for those who are less likely to claim.

Doesn't mean I have to like it, and in fact many of the criteria used to make assumptions about the level of risk (age, gender, even occupation) would probably be considered discriminatory in any other area of business.

But the idea of charging people who have a high BMI (that stupid meaningless measure again) extra even if they're perfectly healthy on the offchance they may develop something expensive is disgusting, discriminatory and fuelled by pure ignorance.

The healthcare system in the US is totally broken and our only hope is to adopt a universal care model under which all US citizens -- regardless of health, age, employment, etc. -- will have access to care

Oh don't you believe it. Whilst I fundamentally believe in universal state-provided healthcare free at the point of use, the fact remains that in the UK we do have such a system (falling apart though it may be due to a population which demands European public services for US levels of taxation) and far from easing the problems of discrimination and resentment against fat people it actually amplifies them - and throws up a whole host of new ones.

The recent shift toward public health promotion and preventative medicine means that there is far more propaganda in the guise of 'advice' being peddled through the media, most of it from 'respectable' Government sources. And because the NHS at central level is a single monolitic entity with a Cabinet Minister in charge, it's also much easier for the frankly huge number of single-issue pressure groups, misguided charities and self-styled 'obesity experts' to force their frequently extreme views on tackling the 'obesity timebomb' onto the Government.

But most importantly, because everyone pays into the system and given the way in which it's been starved of funding over the years, there's an increasing sense of public and media bitterness toward anyone who are accused of taking more than their fair share - smokers, drinkers and fat people.

The fact that supposedly respectable news outlets and professional organisations such as the BBC and the British Medical Journal are now blaming fat people for the resourcing crisis within the NHS is keeping the issue pinned to the top of the health agenda.

The NHS is being used as a stick with which to beat anyone who is considered not to be paying adequate attention to their health back into line, and there have even been proposals advanced to deny fat people treatment for conditions related and unrelated to their size, on the grounds that these are 'self-inflicted'.

With socialised healthcare you add the concepts of fairness and social responsibility to the anti-fat brigade's arsenal of weapons, and that can't possibly be a good thing.

Rio Iriri's picture
Rio Iriri
August 9th, 2007 | Link | That's so nice

So, they threaten your pay if you're fat, have high blood pressure, or other surrogate endpoints that are out of spec. This seems to be a stressful thing to do.

As people who actually educate themselves know, stress can make your blood pressure rise and make you gain weight.

Sounds like a little self-interested corporate bullshiat to increase shareholder profits, eh?

rebelle August 9th, 2007 | Link | Why are these idiots basing

Why are these idiots basing health assessments purely on BMI? BMI is NOT any kind of indicator of actual health. It is a holdover from the "social darwinism" of the Victorian era. It. Does. Not. Demonstrate. Health.
Why don't they just charge "extra" when people actually have to go to the doctor? Oh, wait. That's right. We already pay insurance for that!

And thus, the other part of the perception problems that drive this sort of lunacy: We pay for health insurance because it is *supposed* to provide a service! It's not a compulsory donation to a private business, after all. We're supposed to get something out of it.

Clarion Health has some nerve taking money out of people's pockets purely because of their weight. This kind of mind-bending garbage has to stop before it becomes pervasive. What do we do? There's got to be at least one legislator in Indiana with some common sense and backbone; we should find out who and write him/her, asking for legislation that would prohibit companies like Clarion from simply ASSUMING fat people will cost them more, and make them take their hands out of their fat employees' wallets. That is the point we have to drive home: That it IS an assumption and that, in absence of proof, employers should not be allowed to do this. We might win more sympathy if we were very clear on this particular point; otherwise, we will be written off as "whiners in denial." As per usual. But this is a serious civil rights issue.

kelly_cs's picture
kelly_cs
August 9th, 2007 | Link | Why don't they just charge

Why don't they just charge "extra" when people actually have to go to the doctor?

Because, like all conversations about health care, it is based not on fact, but on appearances and false assumptions. They look at us and SEE fat and ASSUME that we're unhealthy because of it. In their perception, charging any given individual more for increased medical care punishes people who are "innocently" sick -- that is to say, they didn't "do it to themselves" (whereas they believe all fat people are to blame for their size).

Imagine the public reaction to a thin woman (who is apparently responsible for her smallness) being charged 20 times as much for health care because she has breast cancer, while a fat woman is charged nothing additional (because she hasn't needed to seek medical treatment for anything). While it may be more logical to expect people to pay proportionally for the services they require, it would cause widespread outrage in our society which so abhors fatness.

People also seem to forget that the whole point of insurance is to share risk, so that no one person is overwhelmed with medical bills. Yes, this means that people who require less medical attention may pay for more than they get, and people who require more medical attention may pay for less than they get. That's the whole point. Alas, the blame game entered the equation, and ever since, the insurance companies keep looking for ways to increase their profit, even at the cost of excluding people from the concept.

In an ideal world, every person would be charged equally (not dollar amount, but a flat percentage so it would be an equal burden to every income bracket) irrespective of whether or not they've sinned their way to ill health (you know, smoking, drinking, eating too much and not exercising...). But we don't live in an ideal world and we never will. And people are always going to want to blame somebody. It's just easiest to point fingers at those who look guilty.

Without going into the tirade whose gathering storm nearly choked me when I read a couple pages of those Digg comments, I'd also like to reiterate something I read once. It is too simplistic and doesn't support the HAES concept, but it feels so true -- It's not illegal to be unhealthy. Although it certainly appears to be going in that direction

fat_chic's picture
fat_chic
August 10th, 2007 | Link | So who do we write about this?

So here's my question: who do we take this up with? Clearly, this action needs to be protested. So where do I fire off my angry letters? The ACLU? A consumer protection agency? Who has made this legal, and why?

I want to fight this, I'm just not clear on where.

You can find me at:
http://fatchic.dianarajchel.com
http://magickalrealism.etsy.com

jmars August 10th, 2007 | Link | It's legal because employers

It's legal because employers provide the majority of health insurance in this country and can pretty much adopt any rules they want, as long as the same rules apply to all employees. In this case, the rule for all employees is "If your BMI is over 30, you pay an extra $10 a paycheck for health insurance." As long as they don't discriminate by offering different classes of workers different plans (by which I mean, you can't provide your management with one set of healthcare offerings and your non-management employees a different set), the plan is OK.

Want it to stop? Here's what needs to happen.

1. The AMA has to stop lying about fat people becoming thin (i.e., they must stop saying that eating less and exercising more is the "simple" solution that will turn fat people thin) and the media has to stop the hysteria about the "obesity epidemic" and its miscalculated costs. Can someone tell me how much more it costs per year to provide medical care to the average fat person versus the average thin person? Is there really a significant difference? My guess is probably not.

2. We've got to fix the health care delivery system in the US. The administrative costs and profits that are baked in to what we pay account for close to 25 cents for every dollar of health care cost. The insurance companies are terrified that more of us are going to wise up to that fact. So instead, they've got us fighting among ourselves, blaming fat people for the increasing cost of the system, hoping that no one will notice the tens of millions of dollars health insurer CEOs are paid every year. It's disgusting and it's got to change.

Alyssa August 10th, 2007 | Link | Clarian's Plan

I am so outraged by Clarian's "punishment" of fat employees, I'm not sure where to start. Although I am not an attorney and the health care/insurance law is complex, I do not believe employers/insurers can discriminate against legally protected groups. For example, an employer could not dock an African American employee $$ per pay check simply because some research has indicated that Blacks have more health issues than whiltes, e.g., hypertension. On the other hand, few states or municipalities have laws the forbid discrimination based on weight (or some proxy like BMI), and there is no federal prohibition. In those areas, it is perfectly OK to discrminate against fat people. Or, more succintly, it has become open season on fat people. Still I think there may be some basis for legal action against Clarian since it appears they have largely (although) not exclusively singled out fat employees and ignored other, more well established, risk groups. What about older workers? It is well-documented that as individuals age they generally use more health care services. So on each employee's birthday, shouldn't Clarian deduct an increasing amount from their paycheck? What about employees who don't regularly exericise. There is a well-established body of research on the health benefits of exercise. Why not require employees to bring a note from the gym weekly that they worked out at least three times that week for at least 30 minutes? If not, dock them too.

One sane quote from the article heartened me:

"We're in a war for talent, and there are more than enough work-related challenges to manage people and performance that (penalizing) for something that is so complicated, so personal, so hard to deal with, just isn't the right thing to do at this point."

The net effect of Clarian's policies is to further ostracize fat people from the work place as a matter of social discrimination not concern for their health. It is designed to encourage fat people to find employment elsewhere and to discourage fat applicants for job openings.

amanda8501's picture
amanda8501
August 10th, 2007 | Link | They had a news story about

They had a news story about this on tv today, I guess Uhaul docks any employee who smokes or has a BMI over 30 $13 every paycheck. If you are trying to quit or are loosing weight they cut it down to $7.

Now I know in Michigan, blue care network doesn't discriminate against BMI but they do work with doctors to check things like blood pressure and cholesterol, if a person gets worse then their premiums get more expensive.

I'm even uncomfortable with things like that. Stuff like this makes me sick.

paul August 10th, 2007 | Link | The List

So far on the list then we've got:

  • Clarian Health
  • Western & Southern Financial Group
  • U-Haul

Thanks, DeeLeigh, for the idea. Let's keep it updated and rolling!

amanda8501's picture
amanda8501
August 10th, 2007 | Link | Paul - Couldn't we have a

Paul - Couldn't we have a page dedicated to Fat Friendly v.s. Not Fat Friendly Companies, with reasons for why they are being labeled as such? It makes it a far bigger deal to a company when you have someone calling them out on a format like this for being unfair.

paul August 10th, 2007 | Link | Oh, absolutely.

I just wanted to see if anyone else had any other resources for the list first.

Meowzer August 10th, 2007 | Link | "We're in a war for talent,

"We're in a war for talent, and there are more than enough work-related challenges to manage people and performance that (penalizing) for something that is so complicated, so personal, so hard to deal with, just isn't the right thing to do at this point."

This is probably why more companies aren't doing this. I'm sure they'd all love to have a workforce comprised of only young, thin, childless, pretty, perfectly healthy and able-bodied employees with no lives whatsoever who just live to work, work, work and don't care about anything else. But few companies have skill set requirements so interchangeable that if someone falls out of that category of worker, they can just unceremoniously dump them and hire another Perfect Person. My company, for instance, found it took them almost a year to find someone for my job who would stick, someone who was reliable and available and had the skills they needed. A year! You think they're gonna risk pissing me off by docking my fat ass?

And believe me, I would get pissed. If it ever did get to the point where every company was going to dick me in the nethers for health insurance, I think I'd tell them to take their policy and stick it. It's not worth it; at some point, if they keep making insurance more and more and more expensive, that many people are going to blow it off and just go naked and decide to grind up some peach pits at home if they get cancer.

Meowzer August 10th, 2007 | Link | Oh, and also, agreed with

Oh, and also, agreed with whoever said this policy would be violating HIPAA if people declined to disclose their medical info to their employers and the employers used that as an excuse for harassment. If I say, "My cholesterol is none of your freakin' bee-eye, and neither is anything else in my folder," they are legally required to back off. All it's gonna take is one lawsuit, and boom.

beakergirl August 11th, 2007 | Link | slightly off topic but

I think there is a huge problem with doctors and health insurance companies seeing a fat person as just a "ball of fat." No consideration of if there are or are not underlying health issues (And don't even get me started about BMI - what about a short but v. muscular guy who's a body builder? Does his pay get docked because his BMI is "too high"?)

There was a story on - I think it was "Mystery Diagnosis" - that ran today, about a woman with Cushing's Syndrome. She KNEW something was wrong but her doctors just kept harping on her to "lose weight, eat less, exercise more."

It very nearly killed her until she found a doctor (at UCLA, I think) who actually LISTENED to her, did some tests, and said, "Oh, you have a pituitary tumor. We must treat that or you will die. After we treat it your symptoms [which included extreme anxiety, oily skin, and IBS] will resolve."

And you know? They did. But if she hadn't been persistent, if she had believed the jerk doctor who basically said, "You're not really eating as little as you report you are or else you'd lose weight," she'd be dead.

I wonder how many deaths attributed to "obesity" in this country are actually attributable to conditions or syndromes the doctors didn't bother to investigate, because they just saw a "big glob 'o' fat" instead of a hurting person in need of good diagnosis.

And I wonder how many more will happen when we "normalize" the idea of medically and financially penalizing people who are larger....

tayl0500's picture
tayl0500
August 14th, 2007 | Link | Call the ACLU STAT!!

I am so sick and tired of obesity being the only thing that it is still okay to discriminate against. It's not socially acceptable to discriminate against somebody because of sexual orientation, race, gender, religion, economic background (nor should it be) but yet it is still okay in such a "modern society" for companies to enforce archaic policies which blatantly call out a minority group and punish them for not being mainstream. If companies charge for high BMI's because of health risks, then they need to charge for people who smoke cigarettes, who drink, who don't buckle their seatbelts, who don't brush their teeth two times a day, who squint while reading, and the plethora of other so-called health problems that people bring on themselves that raise the cost of health insurance. This wouldn't be a problem if we had socialized medicine. Whether fat, skinny, health nut or crackhead, rich or poor, everyone would be able to go to the doctor, and nobody would have to worry about their livelihood's being taken away from them if they lost control of their bodies because of genetics, mental illness, addiction, or a simple lack of self control. Health care is a human right.

osxgirl's picture
osxgirl
August 15th, 2007 | Link | tayl0500 - Actually, I

tayl0500 -

Actually, I disagree with you - socialized medicine WON'T fix this problem. In fact, I think in many ways, it will make it worse.

Why do I say this? Well, under socialized medicine, the IDEAL is that everyone gets to go to the doctor, no matter what. And that's true, sort of. The problem is, in order to control costs, a rationing of supply inevitably occurs. And how do "they" decide how to ration the supply?

I contend that a lot of the rationing will be done based on how morally "deserving" you are of treatment. Accident victims get first priority. People who have diseases get higher priority. Low-ranking will be people with lung and liver cancer (alcoholics and smokers), people with drug-addict-related conditions, and fat people in general. Because, after all, we all did that to ourselves, according to "them".

It's what's happening with insurance now. The reason insurance companies do it is to reduce costs. Government has NEVER been able to do anything cheaper than the private sector. So socialized medicine will be more costly than it is under the current scheme of private insurance managed by the government. (Medicare and Medicaid only come in cheaper because government mandates the prices as cheaper than the market, which is why so many doctors and hospitals will refuse Medicare/Medicaid patients when possible. When there is no market to subsidize the government anymore, the government will have to find ways to reduce costs.)

Given the current popular thinking, what do you think the government means of reducing health care costs will be? I think it will be exactly what we are seeing - set up a system where a certain amount of "blame" for the state of a person's health is assigned to each person, and that amount of blame will determine the level of care the person receives. It won't be stated that way, but it's what it will boil down to.

Even then, assume the system was instituted in an ideal manner. The inherent prejudices of the doctors would not go away. I don't think fat people would get any better care than they currently get. In fact, I think it would be worse. At least now, if I go to a doctor and that doctor won't treat me because all he can say is "You're fat," I can realize he's an idiot, and go find another doctor. Under socialized medicine, I would no longer have that choice. How am I going to shop around for help when my entry into the system insists there is no problem that weight loss wouldn't cure, and refuses to give me a referral to a new doctor? And there's a waiting list to even get in to see a doctor, and I'm not allowed to just pick a doctor..perhaps I'm even assigned one.

Believe me, I'm no fan of our current health care system, or of the health insurance system as it stands. But socialized health care scares me far more. ESPECIALLY as a fat person!

Skorch August 21st, 2007 | Link | I agree with all you said,

I agree with all you said, except...health care is not a human right. There are no "rights" that require someone else to give you something. Health care is what people who care for each other do for each other when someone is sick or injured...and this society does not care about those whose BMI's do not fall within a "normal" range. If parents have 3 children and one is fat, they love that one the least. Society feels the same.

beakergirl August 15th, 2007 | Link | I have also heard it rumored

I have also heard it rumored (but no evidence to back it up) that in some countries with the system, kids and teenagers get fantastic care (because they're a future part of the tax base) but oldsters (who are on pension and so aren't paying salary taxes) are kind of ignored.

I think socialized medicine is one of those things that sounds great in theory, but won't be so great in practice.

I just shudder to think about health care here becoming like the UK, where a doctor can often say, "Lose 25 pounds [or more], THEN come back to see me."

Kunoichi August 15th, 2007 | Link | if I go to a doctor and that

if I go to a doctor and that doctor won't treat me because all he can say is "You're fat," I can realize he's an idiot, and go find another doctor. Under socialized medicine, I would no longer have that choice.

Huh??? Where did you hear that?

I'm in Canada, and I've lived in 3 different provinces (Medicare is provincial, not federal). We have complete choice in doctors. The only limitation these days is that there's a shortage of doctors taking new patients. Even so, the College of Physicians and Surgeons will help you find a doctor to meet your needs, at no cost. That's how we finally found our current family doctor, but his clinic is so busy, we still use the drop in clinic we were using before. I've had to change doctors many times, and not just because of moves, and have never had my choices limited in any way.

Of all the doctors we've had over the years, only one every brought up my weight (or my husband's) as a possible problem rather than why I went there, and once we found out the true cause of my complaint, she never brought it up again. No other doctor has even mentioned my weight, other than to record it along with my other file stats, or if it was part of my treatment (ie: the amount of tissue removed during my surgery). While I know of some people who've had insensitive dr's in regards to weight, I have NEVER heard of anyone being refused treatment because they were fat.

Correct me if I'm wrong, but as I understand the system in the US, people are limited to the doctors on their insurance company's list, and that if they go anywhere else, they won't be covered.

"Socialized" medicine does have its problems, not the least of which is the expense in taxpayer dollars that gets wasted in the bureaucracy. That seems to be true of all government organizations, and it's a real problem that needs to be dealt with. Having said that, I am thankful and appreciative that we have it, especially after my husband's prolonged illness. We never had to worry about whether or not any of his tests would be covered, or if the various dr's he saw were covered by insurance companies, or doing any more than the most basic of paperwork (which we usually didn't have to do ourselves, anyways), etc. It prevents an amazing amount of stress that would've been there otherwise.

jmars August 16th, 2007 | Link | Kunoichi -- several recent

Kunoichi -- several recent studies have shown that the administrative costs associated with the US patchwork of private and government-run insurance programs is far more expensive than in any western single-payer system. Somewhere around 25% of "health care" costs in the US are actually administrative costs: for example, the costs insurance companies pay in "administration" of claims (which often translate into finding reasons not to pay them or in trying to pass the costs of a claim onto another insurer) and the costs health care providers pay to work with the myriad of insurance companies and plans within companies to try to get paid. The highest single payer system had adminstrative costs of about 14%.

Although there are certainly bureaucratic/adminstrative costs associated with single payer (private or government), the costs of the unbelievably complex US system are much greater. And then there's the $100 billion a year in profits collected by the insurance companies. Those, oxsgirl, are some of the savings we'd realize by moving to a single payer, non-profit (probably government-run) health care system in the US. And we wouldn't have to change ANYTHING ELSE about our system. Doctors would submit bills to the single payer and they'd get paid. On the front-end, there's no reason for anything to change.

As for the question about what doctors we can see, Kunoichi, the answer is "it depends." Virtually every employer in the US has a different health plan (or set of plans, if the employer is large). Some people still have very liberal plans, where they can see any doctor they want. Often, though, these plans require out-of-pocket payment for certain items, like physician visits, with the patient being reimbursed some percentage of the total. Some plans (like the one I have currently) have both "in-network" and "out-of-network" benefits. If I see a doctor in the plan, I pay a co-payment (either $20 or $40, depending on the type of doctor, the way the doctor submits the plan and apparently, the way the claims person feels that day) when I go for my visit. If I chose to see an out-of-network doctor, I have to pay for the visit in full, meet a $2,500 annual deductible before I can be reimbursed for any of the charges, and then I get 70% of what I've paid back until I've paid $5,000 out of pocket for the year, after which I'm reimbursed 100%. Finally, there are plans which, as you describe, provide no coverage if you see a doctor who's not in the plan. When you switch employers, your plan will be switched, and you may have to change doctors.

Having a private insurance system doesn't stop doctors in the US from telling patients to lose weight to resolve health problems. There's a unbelievably heart-wrenching series of blog entries on kateharding.net from July about one woman's loss of her mother because she was made to feel so ashamed of her weight by a doctor that she didn't get proper treatment. This unleashed a whole flood of similar stories. So having a private system hasn't helped us any in that regard.

And then there are the 49 million people who don't have health insurance and who, as a result, typically have only limited access to health care. Usually, that access is only when they have a health emergency. Another recent study found that the costs of not receiving regular medical care are high. When people who haven't had health insurance become old enough to receive Medicare coverage (US government insurance plan for senior citizens -- currently people 65 and older), their costs of treatment for the first several years are significantly higher than the costs associated with patients who were insured prior to receiving Medicare. We're concerned about "rationing" of care after implementing a universal care system, but the truth is that we "ration" care currently by leaving 1/6 of our population without access to it, except in emergencies.

Part of the reason that the calls in the UK and the US have grown so loud to limit access to care by people who have "chosen" a "lifestyle" that "leads" to health problems is that the people who would be affected by these changes have internalized all of the arguments made in support of the limitations: it's your own fault that you're fat; all you have to do to be thin is to eat less and exercise more, blah, blah, blah.

BFB is a great tool for helping people get past that, but there needs to be an organization out there challenging -- in a calm and reasonable manner -- the nonsense that the media perpetuates about fat people. The health risks of being fat have been greatly exaggerated, as have the costs of providing health care to treat the illnesses that are correlated with being fat. The misinformation needs to be fought, and fought hard, because what I see happening in the US is that insurers are using fat people as a scapegoat and a diversion to prevent people from thinking too much about how much money they waste.

I think another thing that needs to be done is to remind people that we aren't hermits living in caves. We live in a society and part of the cost of choosing to live in society is that there are costs we all share. Even if being fat is a "choice" -- or the result of a series of "choices" -- so what? I have chosen not to have children; does that mean that I shouldn't help society bear the cost of caring for and educating the children that other people choose to have? Of course not, so why should people who have "chosen" not to be fat think they can walk away from their responsibility to ensure that everyone in society has the same access to the health care they need?

Again, sorry for such a long entry!

osxgirl's picture
osxgirl
August 17th, 2007 | Link | I agree that the majority of

I agree that the majority of the problems in our present health care system are caused by the overhead, mainly by the cost of insurance, the cost of having that extra layer in the mix. Since the insurance companies are in the business to maximize profit, having them there of course ends up being a bad deal for patients and doctors alike.

Another thing hurting our system is the lack of caps on medical malpractice suits. Right now, lawsuits in medical cases, like lawsuits for pretty much anything, are treated like a lottery. Some are legitimate, some are legitmate but end up asking for way more than they are worth, and some are just playing the odds, hoping to get something for nothing. This makes it all cost a lot more, hiking up malpractice insurance for doctors, which in turn makes them raise their rates, and it trickles down, pricing the poorest out of the market.

The problem with moving to a socialized system is that we won't move to a new, idealized system. There are too many interests in the old system that will fight it. It will never happen. What would actually happen is a gradual move that would actually end up being the old system placed under government control. It's almost inevitable that the only good thing that would come out of it would be that there would be universal coverage for everyone, at least in name. But most likely, most of the bad points of our current system would be carried right along with it. And we would get our typical government inefficiency to boot.

Add to it that in the countries that do have socialized medicine, yes, you may have some people who say they have had great luck with doctors and such. But Kunoichi, even you say that your doctor's office is usually too busy. And for urgent matters... well, let me use my father as an example. Last year, we discovered my father had lung cancer. With what he had, it usually does not have a very good prognosis, partly because it spreads so rapidly, and partly because by the time it is found, it has spread so far that there is little they can do about it.

In my dad's case, we got lucky right off the bat. He had been coughing a little, and the doctor didn't like the cough, and had been bugging him about getting an x-ray. When I say bugging him, I mean bugging him A LOT. My dad has to have checkups monthly because he has had a couple of heart attacks in the past and more recently, had bypass surgery and has a pace maker. If the doctor hadn't really been on his case about the x-ray, he wouldn't have gone. When the doctor saw the x-ray, there was a spot on it. The spot wasn't necessarily THAT unusual, as my dad does also have a touch of emphasyma (sp?). But, for some reason, it concerned his doctor, and the doctor again MADE him go get it checked out further. It turned out to be lung cancer. We were told that they hardly ever see lung cancer get caught that early. It was completely contained in one lobe of his lung. It had not spread at all to his lymph nodes. They took out the one lobe, and did not have to do chemo at all. He is doing fine. They've checked him several times since, and now, a year and a half out, there is absolutely no sign of cancer. Very, very unusual for this type of cancer. Usually, with what he had, it's pretty much a death sentence.

Honestly, I think if we had been under socialized medicine, we would have lost him. Number one, with his list of health problems, he probably wouldn't have been a priority patient. Two, from everything I've seen about socialized medicine (and somewhat experienced it, since when you're in an HMO, it's like being in a mini-socialized system) the doctors usually have a lot of patients, and seldom really know those patients well personally. It's doubtful that one would have worked with and taken the time to scold my dad, make him do what he needed, and have noticed a spot that could easily have been brushed off as just my dad's emphasyma. Three, once they discovere what was going on with my dad, there was NO hesitation, NO waiting. He was in the hospital within 2 weeks, and the only reason it took that long is they had to wait for one of the medicines which thins his blood to get out of his system so he wouldn't bleed to death during surgery. Otherwise, they would have had him in sooner. From articles I've read, in countries with socialized medicine, "urgent" surgeries such as this could have wait times of 4 - 6 months and upwards. That very likely would have meant the difference between life and death for my dad.

And more specific to the problems for fat people - we won't be changing the doctors, we'll be moving the doctors we have to a new system. We won't be changing the system we have for training doctors. We won't be changing the attitudes in this country. Do you think that those attitudes won't affect the way that government system is run? Canada's government is more fat-friendly, so it only makes sense that a government-run health care system in Canada would be more fat-friendly. In this country, it is going the opposite way, which makes me shudder to think what might happen to my health care under a government-run system.

I really don't know what the solution to the health care problem is in this country, though if I were to make a stab at it, I would want to try and replace the health insurance companies with an equivalent that would be like a credit union is compared to a bank (where the bank = health insurance company in the comparison). Where people who are paying in are not customers, but "owners", and where the "insurance company" is non-profit. I think having it private-run, rather than government-run is still best, because then it doesn't become a political chip that politicians try changing and using to get elected. That's how stuff like that gets screwed up. The less government is involved in it, the better. But it needs to be a large group thing, so that risk can be spread over a large pool of people - that's what gives you the money to cover catestrophic illness and such. Minimal overhead, invest as much of the money a possible to get returns to fold back in to help cover claims.... Where the insurance model mostly falls down is the fact that profits have to come out of it. If it is more like the credit union model, where there are no profits being paid out, it would have a much better chance of being self-sustaining, I think. The problem is finding and organizing a big enough group to create and run such an "insurance".

Well, that's my "brilliant" idea for the day. If I had the money and time to back it up........ sigh.....

Kunoichi August 17th, 2007 | Link | Thanks, jmars, for all that

Thanks, jmars, for all that info. It answered quite a few questions that I had about the US system.

Osxgirl, I think I need to clarify a bit about my comment re: our new dr's clinic being so busy, we still use another walk in. This was for walk in only. Busy as it is, there's no delay for pre-booked appointments. Our new dr. is in a well established downtown clinic with a large patient base. If there's a staff shortage, they can't take walk in's, but pre-booked appointments are unaffected (unless the dr. himself gets sick. *L*). To use our most recent example, my husband has an old injury that started acting up again. He went to our new dr's office and they happened to be short staffed that day, so he walked up the block to the walk in we'd been using before. He was taken to an examination room immediately after his file was pulled, and the dr. came in almost before my husband had a chance to ease himself into a chair. We've always been happy with this particular clinic, but they do walk ins only, so we had to turn elsewhere for a regular dr.

Most of Canada has major problems with dr. shortages. This is especially true of rural areas, or places like some areas of Alberta, which is going through an incredible boom right now. People can't even find places to live, never mind doctors. We simply don't have enough general practitioners for the number of people who need them, and most gp's don't want to work in rural areas. In some areas, there are additional problems with lack of equipment, or lack of qualified techs to operate the equipment. This does not, however, prevent people from getting urgent care. I hear the stories about people being on waiting lists for months, sometimes years, and I truly don't understand why that's true for so many people.

Just to use a few examples. My father had a series of strokes quite a few years ago - 5 that we know of, with the 3rd one leaving him paralyzed on one side. The first two, he didn't know what had happened and had ignored the effects. After the third one put him in the hospital, he received immediate care, being transfered to a health sciences centre in the city. He was only there for a remarkably short time (1 month, if I remember correctly) and, between their care and his own stubbornness, had regained almost full use of his paralyzed side by the time he left. He's since received constant, meticulous care not only from his own doctor, but from the specialists in the city he travels to see less frequently.

Some years later, he started having seizures. Again, he ignored them until one of my brothers was there to see it and immediately drove him to the closest local hospital. Before we knew it, my dad was transfered to the city again and getting a pacemaker - he was in surgery within two hours of my brother seeing the seizure and dragging my dad to the dr, which is saying a lot considering it takes almost a full hour to get to the city, plus the time it took my brother to drive him to the neighbouring town my dad's dr. is in, etc.

Then there's my husband. His health took a sudden crash that he's still not completely recovered from. At the time, the clinic our dr. was at also doubled as a walk in, and it's always busy. At one point, we were bringing him in 2-3 times a week. After a while, our dr. told the receptionist that if my husband came in, he was to be taken in immediately, regardless of who else was there, or even if she were seeing another patient. He had so many tests, they were running out of ideas. Frequently he never even had to make appointments for the tests. He just showed up at the lab and they took him immediately. They even tried sending him to a shrink, just in case it was in his head somehow. Even that had no delays (and after a few sessions, my hubby was told not to come back, as whatever was wrong with him, it was physiological, not psychological).

When sleep apnea was brought up as a possibility for at least some of his troubles, it was a slightly different story. There were no local facilities. There was a sleep research lab in the city, but they only had 7 beds. We were told to expect to wait many months, at least. His file was marked urgent, however, and when they got a cancellation, he was on the top of the list. They squeezed him in on the last night before Christmas holidays. The only reason his diagnosis waited 2 weeks was because the specialist was away for that long. When a CPAP was prescribed, we were again told to expect at least 3 months. Again, because of the urgency of his case, when they had a cancellation a week later, they called him. The only reason we didn't get his machine then was because of the timing. We couldn't get to the city fast enough. Even so, he had his machine a week later. It took almost a full year before they found a pressure setting and mask/hose system that worked for him, and when new versions came out, they called him in to try the new, improved versions. He was given hose extensions, a humidifier, carrying case, 6 months of the 2 different kinds of filters - they even replaced the machine outright when it started giving off an electrical smell. None of which is available in our new province, which doesn't cover CPAP machines and supplies at all. Sticking out tongue We have to pay for that up front, though he does have insurance now that covers part of it, plus we can claim the rest at tax time.

I can tell other similar stories, including my own surgery (I was told to expect at least a 9 month wait, but I got it in less than 4 weeks, and there was nothing life threatening about my troubles), my daughter finding a lump on her neck, and so on.

A government run system certainly has its problems, but it doesn't have quite the problems people sometimes attribute to it, and some of the problems are more local issues, not system issues (I can give as many horror stories as I can success stories and they all involve individual people not doing their jobs right, not the system itself). Osxgirl, if your dad had been in Canada (I can't speak for other countries), I don't think his treatment necessarily would've been any less than than what he got where he is now. It sounds like he had a great doctor that was on the ball - and we have those here, too, even under a government run system. Of course, we'll never know one way or another, thank God for that. Eye-wink I also don't think that the HMO in the US is all that much like the medicare system in Canada.

As for your ideas for an alternative, very interesting. It sounds a lot like a co-operative.

Bilt4Cmfrt's picture
Bilt4Cmfrt
August 20th, 2007 | Link | Get your hand out of my pocket!

This is crazy. It's stupid, discriminatory, and what's more, it's fucked up. In every way imaginable. Yet I've seen it mentioned/thretened in one form or another several times before with the inevitable, annoyingly frustrating, answer; 'Well, there's not much we can do about it.' Huh? Fat people are being mugged, on the street, in broad daylight, with a cop standing right there providing tips for the Efficient Mugger and there's 'not much we can do about it'?

I find myself in agreement with fat chic's question and sentiment;

Clearly, this action needs to be protested. So where do I fire off my angry letters? The ACLU? A consumer protection agency? Who has made this legal, and why?
I want to fight this, I'm just not clear on where.

And with rebelle's;

What do we do? There's got to be at least one legislator in Indiana with some common sense and backbone; we should find out who and write him/her, asking for legislation that would prohibit companies like Clarion from simply ASSUMING fat people will cost them more, and make them take their hands out of their fat employees' wallets.

jmars--You are, of course, right on both points concerning the AMA and Big Insurance. These are two points that MUST be addressed not only in reference to the Obesity Propaganda Epidemic but also in society in general (There are more than a few CEOs being paid WAY too much to prop up their really expensive desks), but I still find myself sorely in need of doing something, like RIGHT NOW. Letter writing campaigns, contacting congressmen, I'd even go for an anonymously sent e-mail to every employ of any company that tries a stunt like this with nothing but the words 'Your company may be discriminating against you. Get a lawyer.' in 30 point bloc caps.

I guess i feel so strongly about this particular issue because I see it as being both a beach head for anti fat legislation and because I feel it might be right on the cusp. Sitting on a razors edge waiting to fall one way or another depending on which way it's pushed. Corporate America and Big insurance would, of course, love to have it fall on which ever side increases profits or decreases cost and damn whoever suffers. The questions, it seems, are what are we willing to put up with or let them do TO us and when, if ever, do we start pushing back?

jenhuff September 1st, 2007 | Link | insurance

I buy my homeowners and auto insurance froma mutual company because the rates are the lowest - even lower than Geico and AIG. Health insurance would be the same if a mutual company offered it. With no shareholders demanding profits, there is no incentive to raise rates beyond what it necessary. Since the policy owners 'own' the company, the pressure just isn't there. I would love to see a mutual company offer a really top notch health insurance plan.

stefanie_bee September 7th, 2007 | Link | I am not a lawyer, but

I am not a lawyer, but articles like this make me wish I was.

To me, it seems that already-existing discrimination law *could* be used to sue these companies. As someone mentioned above, an employer offering a group insurance plan to employees wouldn't charge someone more for insurance if they were of a minority group, or if they were old, or a childbearing-age woman.

Yet it's acceptable to charge fat people more.

What we need is to have body size *included* to the 1964 Civil Rights act, with regard to employment, access to public facilities, etc. What San Francisco is doing is great, but that's only one city. It needs to be extended nationwide.

vesta44's picture
vesta44
September 9th, 2007 | Link | This article link references

This article link references Clarian's policy of penalizing insured who don't meet their criteria of health, and goes on to list other companies and insurers who are doing the same thing.

The National Workrights Institute says employers adopting the charges are trying to control private behavior and amassing huge amounts of personal health information.

"It's a backdoor approach to weeding out expensive employees," legal director Jeremy Gruber said.

Employers wary of risking legal problems feel more confident after federal regulations were finalized July 1 covering how wellness programs can comply with nondiscrimination requirements under the Health Insurance Portability and Accountability Act. Rewards (and therefore penalties) based on health factors cannot exceed 20 percent of the total cost of employee health coverage.

Employers also are warned that they must consider other federal and state laws, including the ADA.

So employees are going to be mandated to lose weight to meet an arbitrary BMI, regardless of their health, in order to save money on insurance premiums. What happens when they regain the weight and end up in worse health because of the dieting? More penalties, more dieting, even worse health? And of course, it's the fat person's fault because they just aren't trying hard enough, or they're lying about what they eat/how much they exercise. (sarcasm on) Everyone knows that diets work if you try hard enough, and if you lose weight, you are automatically going to be healthy. Everyone knows that they have perfect control over their health and genetics has nothing at all to do with it. (sarcasm off)
*head desk*
Any time one company is successful at this kind of discrimination, it opens the door for others to follow and we lose ground. What is really scary is that the people who are being penalized are buying into the lies and hypocrisy and going along with it, because of course, it's for their health (and I have some swampland in Arizona I'm willing to sell them).
it's all right to be crazy, just don't let it drive ya nuts!

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