Be Healthy or Else: How Corporations Became Obsessed with Fitness Tracking(backchannel.com)
backchannel.com
Be Healthy or Else: How Corporations Became Obsessed with Fitness Tracking
https://backchannel.com/be-healthy-or-else-how-corporations-became-obsessed-with-fitness-tracking-b0c019faff8d#.wes4gmn96
175 comments
>>> And given how my insurance doesn't even cover a 30-minute ER visit without sending me a bill in the mail for $1700, it's hardly even worth having insurance at all. At least at my age.
Until you show up uninsured at the same ER for the same visit and end up with a $10,000 bill because you don't have insurance.
Whether it hits your deductible or not, insurance negotiates rates that are easily 75% cheaper than what you'd pay without it.
Until you show up uninsured at the same ER for the same visit and end up with a $10,000 bill because you don't have insurance.
Whether it hits your deductible or not, insurance negotiates rates that are easily 75% cheaper than what you'd pay without it.
So where in the world are there services you can pay to negotiate your bills downward without keeping them on retainer?
> Until you show up uninsured at the same ER for the same visit and end up with a $10,000 bill because you don't have insurance.
That's the problem, though. If I can't afford it, then it doesn't matter whether they charge me $1,700 I don't have, or $1,700,000 I don't have. Either way, I'm not going to pay it, and it's going to end up going to collections and dinging my credit.
Let's say the worst possible case happens and I get cancer. They don't treat you for that in the ER, other than the bare minimum to keep you alive. But to get those ungodly expensive $3,000 a dose drugs would require too much out of pocket. I wouldn't be able to get them with or without insurance.
That's the problem, though. If I can't afford it, then it doesn't matter whether they charge me $1,700 I don't have, or $1,700,000 I don't have. Either way, I'm not going to pay it, and it's going to end up going to collections and dinging my credit.
Let's say the worst possible case happens and I get cancer. They don't treat you for that in the ER, other than the bare minimum to keep you alive. But to get those ungodly expensive $3,000 a dose drugs would require too much out of pocket. I wouldn't be able to get them with or without insurance.
If you come in with a cash payment offer you can likely get the same discount. You do have to be willing to do a bit of negotiating however. Because nobody without insurance is actually paying those $10,000 bills.
That is false. You will typically get a 10% or 15% cash discount from the hospital ticket price. Still easily 3x what an insurance company would negotiate for you.
Some hospitals allow you to fill out extensive paperwork to apply to have greater bill reductions, and you need to send in several years of tax returns, bank statements, a personal financial statement, an explanation of your situation and why you can't pay in full, etc. It's a grueling, paperwork intensive, and invasive process.
Some hospitals allow you to fill out extensive paperwork to apply to have greater bill reductions, and you need to send in several years of tax returns, bank statements, a personal financial statement, an explanation of your situation and why you can't pay in full, etc. It's a grueling, paperwork intensive, and invasive process.
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A great way to coerce individuals into having their genetics profiled so it can be used in business decisions. This is amusing to me as a biologist, because the methylation apparatus and mRNA splicing suggests that etiology of "genetic disease" is vastly more complicated than simply possessing certain mutant alleles. Though, certain genetic diseases do proceed in this manner, and the mission of molecular biology going forward is to develop methodologies which approximate hardness in an intrinsically chaotic system. Large sample sizes, meta-analyses, etc.
This is one of those "preliterate peoples do not develop epidemic myopia" sort of things, perhaps.
This is one of those "preliterate peoples do not develop epidemic myopia" sort of things, perhaps.
Jesus. My ER copay was $50. How much per month is your plan?
I don't actually know how much my plan is per month. It's not clearly listed anywhere I can find. It's the top plan my company offers, though.
Here's the actual ER bill as proof of what they charged me:
https://twitter.com/byuu_san/status/776137889348358144
Here's the actual ER bill as proof of what they charged me:
https://twitter.com/byuu_san/status/776137889348358144
> I don't actually know how much my plan is per month. It's not clearly listed anywhere I can find.
The amount you pay every pay period, to your insurance plan and to your health savings account (if applicable), really ought to be on your pay stub. If you're paid electronically your company probably makes that available to you somehow via pdf.
The amount you pay every pay period, to your insurance plan and to your health savings account (if applicable), really ought to be on your pay stub. If you're paid electronically your company probably makes that available to you somehow via pdf.
Yeah, but they do an $8,000 CAT scan when you're in the ER. Not $50 any more.
Yep, exactly. They don't tell you how much it costs, and how little your insurance is going to cover. And they also don't tell you that they could've detected kidney stones without a year's supply of radiation into your abdomen, and without all the expense, by using an ultrasound instead. You learn that after researching the matter after you feel better and get your bill in the mail.
You go there in the worst pain of your life (kidney stones are truly terrifying), and you think they're there to help you. Not use you to pay for their fancy, unnecessary, dangerous toys.
You go there in the worst pain of your life (kidney stones are truly terrifying), and you think they're there to help you. Not use you to pay for their fancy, unnecessary, dangerous toys.
Well, I'm talking about the out of pocket expense when you're covered. My ER visit wasn't $50 either, technically; the ambulance bill alone was 50x the copay, in the itemized bill they mailed me. But I was personally responsible for very little of it.
>If he chooses not to participate in the program, Abrams must pay an extra $50 per month toward his premium.
Is he paying $50 more for not participating, or getting a $50 discount for participating?
If it's the latter (Anthem insurance doesn't change their premiums, but now rewards people for using preventative medicine), then how could anyone object? It really is a win-win, and people who don't want to participate are no worse off.
But, if Anthem Insurance aren't trying to motivate healthier behavior, but only trying to identify people who are already trying to become healthier (or stay healthy) and lower their premiums in order to remain more competitive, then it's the former. Workers are being penalized because P(Not trying to be healthy | Doesn't participate in the wellness program) is greater than P(Not trying to be healthy).
What this actually means: The trying-to-be-healthy population are no longer subsidizing the not-trying-to-be-healthy population. I don't know if this is a bad outcome, I remember hearing an interview with Cathy O'Neil (the author) where she applies the same rhetoric and logic to loan approval and to criminal sentencing, in both cases she ignores the fact that going from the status quo (in this case, one where wellness programs exist) to her preferred reality (in this case, one where wellness programs do not exist) tends to take a lot of innocent people who are winners in the status quo (in this case, people who try to stay healthy, and enjoy lower premiums) and makes them into losers (since now they have to pay the same premiums as people who don't use preventative medicine).
> Except, as it happens, this regimen already exists and it’s called humiliation and fat-shaming. Have someone tell you you’re overweight, or pay a major fine.
I'm not overweight, so maybe I don't have the right perspective on this, but how terrible could "having a doctor tell you that you're overweight" be? Like, the only context I can understand this quote is that "Have someone tell you you're overweight" is some sort of grievous injury, and not just trivially inconvenient.
Is he paying $50 more for not participating, or getting a $50 discount for participating?
If it's the latter (Anthem insurance doesn't change their premiums, but now rewards people for using preventative medicine), then how could anyone object? It really is a win-win, and people who don't want to participate are no worse off.
But, if Anthem Insurance aren't trying to motivate healthier behavior, but only trying to identify people who are already trying to become healthier (or stay healthy) and lower their premiums in order to remain more competitive, then it's the former. Workers are being penalized because P(Not trying to be healthy | Doesn't participate in the wellness program) is greater than P(Not trying to be healthy).
What this actually means: The trying-to-be-healthy population are no longer subsidizing the not-trying-to-be-healthy population. I don't know if this is a bad outcome, I remember hearing an interview with Cathy O'Neil (the author) where she applies the same rhetoric and logic to loan approval and to criminal sentencing, in both cases she ignores the fact that going from the status quo (in this case, one where wellness programs exist) to her preferred reality (in this case, one where wellness programs do not exist) tends to take a lot of innocent people who are winners in the status quo (in this case, people who try to stay healthy, and enjoy lower premiums) and makes them into losers (since now they have to pay the same premiums as people who don't use preventative medicine).
> Except, as it happens, this regimen already exists and it’s called humiliation and fat-shaming. Have someone tell you you’re overweight, or pay a major fine.
I'm not overweight, so maybe I don't have the right perspective on this, but how terrible could "having a doctor tell you that you're overweight" be? Like, the only context I can understand this quote is that "Have someone tell you you're overweight" is some sort of grievous injury, and not just trivially inconvenient.
>I'm not overweight, so maybe I don't have the right perspective on this, but how terrible could "having a doctor tell you that you're overweight" be? Like, the only context I can understand this quote is that "Have someone tell you you're overweight" is some sort of grievous injury, and not just trivially inconvenient."
In my experience? It's a drain, and a good way to encourage me not to go see the doctor. Because it's every time I go to the doctor for literally my entire life. I have never not gotten a 10 minute lecture, including when I was on a varsity swim team.
Beyond that, it's a lecture that comes even when it's not the problem. In the not so recent past, we discussed my weight for 15 minutes...and the active pertussis infection I had for 5. If you have a chronic condition, you're almost certainly going to have your doctor tie it to your weight.
And here's the thing - fat people know we're fat.
In my experience? It's a drain, and a good way to encourage me not to go see the doctor. Because it's every time I go to the doctor for literally my entire life. I have never not gotten a 10 minute lecture, including when I was on a varsity swim team.
Beyond that, it's a lecture that comes even when it's not the problem. In the not so recent past, we discussed my weight for 15 minutes...and the active pertussis infection I had for 5. If you have a chronic condition, you're almost certainly going to have your doctor tie it to your weight.
And here's the thing - fat people know we're fat.
The solution doctors should provide starts with mental health (motivation, etc), not physical solution. This is the biggest problem in health care!!!
Note that the US government is doing nothing to change this. It's almost illegal for doctors to "prescribe" mental solutions over physical. Everyone wants a quick fix but the solution starts in the brain.
If you don't want the $50 savings then save the .125% of your salary and don't do it. Simple. Don't act like you don't have a choice.
Note that the US government is doing nothing to change this. It's almost illegal for doctors to "prescribe" mental solutions over physical. Everyone wants a quick fix but the solution starts in the brain.
If you don't want the $50 savings then save the .125% of your salary and don't do it. Simple. Don't act like you don't have a choice.
In a just world, this would be at the top of the thread.
When you put it like that, it does sound very unpleasant.
It is. The last post also ignored some larger problems - like fat people essentially having medical problems missed because doctors attribute it to their weight, or the exact opposite - skinny people not getting diabetic tests or cardiac stress tests because they're skinny.
The blood tests that are part of most medical insurance wellness plans now do check for diabetes symptoms. If your blood glucose or A1c is above the reference range then it will get flagged for your doctor as a possible diabetes case regardless of whether you're fat or skinny.
vectorwhat(2)
Is he paying $50 more for not participating, or getting a $50 discount for participating?
This is just semantics. In either case, it costs money to not participate.
Marketers like to frame things as the latter, as behavioral economics tells us you get better participation by using the latter words.
But we should draw a distinction between marketing and the bottom line. The bottom line is there's a $50 cost.
This is just semantics. In either case, it costs money to not participate.
Marketers like to frame things as the latter, as behavioral economics tells us you get better participation by using the latter words.
But we should draw a distinction between marketing and the bottom line. The bottom line is there's a $50 cost.
No its not according to numerous psychology studies
> If it's the latter (Anthem insurance doesn't change their premiums, but now rewards people for using preventative medicine), then how could anyone object? It really is a win-win, and people who don't want to participate are no worse off.
I would object. What would stop them actually rising the bonus or the costs for the rest in the future? You've justified it in so many ways. It's the grand health initiative! Let's make America healthy again!
Easy to sell and all that sweet data can be used for other good causes.
Meanwhile the discussion over overpriced medicines disappears. You can (must?) even push the prices for medicines, therapies, etc. leading to the fact that the insurances best customers, people who can't do anything about their sickness (anymore) will be burdened even more. Enforcing the "sick and out" narrative in this sick system.
> What this actually means: The trying-to-be-healthy population are no longer subsidizing the not-trying-to-be-healthy population. I don't know if this is a bad outcome
It is. It's like taxes but we lost that viewpoint (US maybe never even had it but we did in Germany) because of privatization.
There are other ways to educate people on how to be healthy and what the benefits are. Starting doing it at school SERIOUSLY would be a step. Marking obviously unhealthy food as such is another. Misleading advertisements is a big one. And so on. It can be done but I don't believe there is a really strong lobby for that out there. Or not strong enough.
I would object. What would stop them actually rising the bonus or the costs for the rest in the future? You've justified it in so many ways. It's the grand health initiative! Let's make America healthy again!
Easy to sell and all that sweet data can be used for other good causes.
Meanwhile the discussion over overpriced medicines disappears. You can (must?) even push the prices for medicines, therapies, etc. leading to the fact that the insurances best customers, people who can't do anything about their sickness (anymore) will be burdened even more. Enforcing the "sick and out" narrative in this sick system.
> What this actually means: The trying-to-be-healthy population are no longer subsidizing the not-trying-to-be-healthy population. I don't know if this is a bad outcome
It is. It's like taxes but we lost that viewpoint (US maybe never even had it but we did in Germany) because of privatization.
There are other ways to educate people on how to be healthy and what the benefits are. Starting doing it at school SERIOUSLY would be a step. Marking obviously unhealthy food as such is another. Misleading advertisements is a big one. And so on. It can be done but I don't believe there is a really strong lobby for that out there. Or not strong enough.
I think it makes sense in the US because health insurance is a for-profit business here. It seems odd to criticize an insurance business for giving lower pricing to people who are less likely to use the insurance. I think it's a terrible way to run a healthcare system, but that's a different discussion.
Edit: (RTFA!) So, it's not the insurers, but the people paying for the insurance. One step removed from what I said, but I think the rest still applies.
Edit: (RTFA!) So, it's not the insurers, but the people paying for the insurance. One step removed from what I said, but I think the rest still applies.
> It seems odd to criticize an insurance business for giving lower pricing to people who are less likely to use the insurance.
It looks naive to assume that, together with the infrastructure costs and the running costs for this system this for-profit business wants to make less money.
What would the selling discussion have looked like? "Hey I have a system here that will make the most credit worthy clients pay less. Interested?"
It looks naive to assume that, together with the infrastructure costs and the running costs for this system this for-profit business wants to make less money.
What would the selling discussion have looked like? "Hey I have a system here that will make the most credit worthy clients pay less. Interested?"
This is basically completely backwards. Also, you seem to be criticizing this solution because its not perfect. Hint: there is no perfect solution.
I don't criticize it because it's not perfect. I criticize it because it opens an massive exploit onto people who are already giving more away of themselves then it's good for anyone. There is also a critique towards the greed that drives those companies and will therefore lead to this exploit being exploited.
"tends to take a lot of innocent people who are winners in the status quo (in this case, people who try to stay healthy, and enjoy lower premiums) and makes them into losers (since now they have to pay the same premiums as people who don't use preventative medicine)."
It's not obvious to me, in the US medical system, that "healthy" people use fewer healthcare dollars over their lifetimes.
Of course I'd like that to be the case and it would be satisfying to shift costs to people making relatively poorer health decisions.
The problem is, it appears that healthcare spending skyrockets asymptotically at the very end of life - as you are literally dying - and that explosion of costs and care-use occurs regardless of how healthy you were throughout your life. Healthy people (and their relatives) desperately attempt to eke out extra days and weeks of life just like unhealthy people (and their relatives) do.
I don't know how to solve this problem but until this is no longer the case I don't think it's appropriate for "healthy" people to act so wounded about the money they're paying in for the couch potatoes.
It's not obvious to me, in the US medical system, that "healthy" people use fewer healthcare dollars over their lifetimes.
Of course I'd like that to be the case and it would be satisfying to shift costs to people making relatively poorer health decisions.
The problem is, it appears that healthcare spending skyrockets asymptotically at the very end of life - as you are literally dying - and that explosion of costs and care-use occurs regardless of how healthy you were throughout your life. Healthy people (and their relatives) desperately attempt to eke out extra days and weeks of life just like unhealthy people (and their relatives) do.
I don't know how to solve this problem but until this is no longer the case I don't think it's appropriate for "healthy" people to act so wounded about the money they're paying in for the couch potatoes.
There are many parts of what you're saying I disagree with.
Here's some work from Harvard establishing that obesity does incurr a higher healthcare cost burden (https://www.hsph.harvard.edu/obesity-prevention-source/obesi...)
I can cite similar articles for excessive smoking/drinking as well, and as anecdata the physicians in my family firsthand support the statements in the above.
You're absolutely right re: asymptotic end of life costs, and I would be in full support of a rethink to the ROI on those costs (especially if they're being footed via e.g. medicare/other tax based resources)
But if anything I think this is _more_ reason for healthy people to be angry, as I'd argue that the upper bound on marginal benefit to keep a 90 year old alive another year as opposed to proactively treating smoking/obesity is probably far lower. (just by the empiricism that even in a best case the 90 year old probably doesn't have as much time left)
At the end of the day, the amount of money that my employer reports as paying for insurance is _astounding_ and I've yet to see any data to support that it's being used effectively, especially given trends of increasing rates without commensurate gains in QOL/life expectancy (there has absolutely been gains but most of the recent cost hikes have been political and divorced from a more needs based cost growth, assessing "need" as per net long term outcomes)
As I said in another post, I've had to surmount a few stress based/sedentary based injuries, and to be bluntly selfish, I'd rather that money to buy myself more stability/a faster retirement so that I may better take care of my own body and not incur a heavy cost on others later in life. (or worse, cut years off my own)
Here's some work from Harvard establishing that obesity does incurr a higher healthcare cost burden (https://www.hsph.harvard.edu/obesity-prevention-source/obesi...)
I can cite similar articles for excessive smoking/drinking as well, and as anecdata the physicians in my family firsthand support the statements in the above.
You're absolutely right re: asymptotic end of life costs, and I would be in full support of a rethink to the ROI on those costs (especially if they're being footed via e.g. medicare/other tax based resources)
But if anything I think this is _more_ reason for healthy people to be angry, as I'd argue that the upper bound on marginal benefit to keep a 90 year old alive another year as opposed to proactively treating smoking/obesity is probably far lower. (just by the empiricism that even in a best case the 90 year old probably doesn't have as much time left)
At the end of the day, the amount of money that my employer reports as paying for insurance is _astounding_ and I've yet to see any data to support that it's being used effectively, especially given trends of increasing rates without commensurate gains in QOL/life expectancy (there has absolutely been gains but most of the recent cost hikes have been political and divorced from a more needs based cost growth, assessing "need" as per net long term outcomes)
As I said in another post, I've had to surmount a few stress based/sedentary based injuries, and to be bluntly selfish, I'd rather that money to buy myself more stability/a faster retirement so that I may better take care of my own body and not incur a heavy cost on others later in life. (or worse, cut years off my own)
> Workers are being penalized because P(Not trying to be healthy | Doesn't participate in the wellness program) is greater than P(Not trying to be healthy).
This assumes the only reason for not participating is lack of motivation to be healthy. What about those of us who don't want to voluntarily surrender our entire genetic code to an insurance company? And once most people have, how do you know that your future premiums won't be based on genetic markers for certain diseases?
This assumes the only reason for not participating is lack of motivation to be healthy. What about those of us who don't want to voluntarily surrender our entire genetic code to an insurance company? And once most people have, how do you know that your future premiums won't be based on genetic markers for certain diseases?
Then don't. If you make 40k a year its only .125% of your salary.
I don't.
But you avoided his entire second question.
But you avoided his entire second question.
It should be. A sustainable solution to increasing costs certainly isn't perfect. If a perfect solution exists its certainly not sustainable. This is econ 101. We need to be thinking not just of poor people now but the millions more poor people of the future - which systems makes them the least poor?
Please read up on adverse selection and moral hazard. The world isn't puppies and rainbows. Sustainability is the most important thing for any market when it comes to helping the poor in the very long term.
Please read up on adverse selection and moral hazard. The world isn't puppies and rainbows. Sustainability is the most important thing for any market when it comes to helping the poor in the very long term.
Who believes in puppies and rainbows? lol
A sustainable insurance market is also obtainable without genetic information. In fact, without any patient information at all. Information allows segmenting the population to allow for diverse premiums. Without any patient information the premium will just reflect the whole population risk.
We can argue if this system is fair or not (I don't like these discussion because they hinge on the definition of fair, which is silly); but your point is about economic feasibility, and it's quite feasible to have a health care system without digging up dirt on everyone.
And, as a libertarian, I have to admit that this country has one of the most inefficient health care systems in the world. The amount of money we spend for results that are worse than any other industrial country is obscene!
A sustainable insurance market is also obtainable without genetic information. In fact, without any patient information at all. Information allows segmenting the population to allow for diverse premiums. Without any patient information the premium will just reflect the whole population risk.
We can argue if this system is fair or not (I don't like these discussion because they hinge on the definition of fair, which is silly); but your point is about economic feasibility, and it's quite feasible to have a health care system without digging up dirt on everyone.
And, as a libertarian, I have to admit that this country has one of the most inefficient health care systems in the world. The amount of money we spend for results that are worse than any other industrial country is obscene!
Disclaimer: I am paid by my employer, a 3rd party provider of wellness programs, to write health incentives software.
It's always phrased as the former, but employees that don't get the discount often see it as the later.
It's always phrased as the former, but employees that don't get the discount often see it as the later.
Wait, it's phrased as a pay cut, but those who lose out see it as a bonus for those who benefit? That would be surprising. Did you mix up "former" and "latter"?
>Is he paying $50 more for not participating, or getting a $50 discount for participating?
On the other hand, think about it like this:
What if insurance costs $10,000 a month, with a $9900 discount for "healthy behavior", so your average person pays $100 a month.
It's a great deal.
Now what happens if someone gets sick and can't upkeep his healthy behavior?
He loses his insurance.
This defeats the purpose of health insurance, but most people tend not to think of long-term repercussions.
On the other hand, think about it like this:
What if insurance costs $10,000 a month, with a $9900 discount for "healthy behavior", so your average person pays $100 a month.
It's a great deal.
Now what happens if someone gets sick and can't upkeep his healthy behavior?
He loses his insurance.
This defeats the purpose of health insurance, but most people tend not to think of long-term repercussions.
To me it looks like people who were born healthy get higher salary.
Overweight or not (I am overweight) exercise is really important. As long as it doesn't result in hiring or advancement bias, it should be incentivized because it lowers corporate benefit costs in aggregate and improves the performance of the workforce. A large body of scientific studies exist showing that it:
Improves cognitive function (https://www.ncbi.nlm.nih.gov/pubmed/24696506)
Reduces sick leave (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2092583/)
Improves happiness/ more brain cells (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789405/)
Smarter, happier people that miss less work are going to be more successful. Some people are born more gifted in this respect, but exercise can be very effective at narrowing that advantage for the rest of at surprisingly little cost in money and time.
Improves cognitive function (https://www.ncbi.nlm.nih.gov/pubmed/24696506)
Reduces sick leave (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2092583/)
Improves happiness/ more brain cells (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789405/)
Smarter, happier people that miss less work are going to be more successful. Some people are born more gifted in this respect, but exercise can be very effective at narrowing that advantage for the rest of at surprisingly little cost in money and time.
Yes. This is true for literally (quite literally!!) every trait in humans that is positive and noticeable.
Isn't that true anyway due to bias? I believe taller men or women with bigger chests make bigger paychecks all else equal. I think in a geek world all paychecks would be determine by work ethic and brain power, but I don't think that's how the world works.
That might be true if a woman works as a waitress (and attracts customers to come more often) but I doubt that is important for a software developer.
No, it has a significant impact even on programmers, though less of one than it has on people in sales or customer service: http://timothy-judge.com/Height%20paper--JAP%20published.pdf
Look it up. People with nice faces and certain hair also make more. Humans have a hard time not showing bias in all parts of their life.
Maybe it's true due to human psychology but that doesn't mean we should institutionalize it.
>>> but how terrible could "having a doctor tell you that you're overweight" be?
How terrible would it be to have a doctor tell you to stop smoking? Or to stop drinking? Or stop abusing drugs? Or to stop cutting yourself? It's all self destructive behavior just like overeating.
Has our culture really become so sensitive that it's now no longer acceptable for a doctor to tell you when you're being unhealthy and contributing to your own demise????
How terrible would it be to have a doctor tell you to stop smoking? Or to stop drinking? Or stop abusing drugs? Or to stop cutting yourself? It's all self destructive behavior just like overeating.
Has our culture really become so sensitive that it's now no longer acceptable for a doctor to tell you when you're being unhealthy and contributing to your own demise????
> How terrible would it be to have a doctor tell you to stop smoking? Or to stop drinking? Or stop abusing drugs? Or to stop cutting yourself? It's all self destructive behavior just like overeating.
It's not terrible, it's just pointless. Fat people know they're fat; people who self harm know they self harm and they know it's not ideal.
Merely saying "stop doing that" does nothing ot help them stop.
It's not terrible, it's just pointless. Fat people know they're fat; people who self harm know they self harm and they know it's not ideal.
Merely saying "stop doing that" does nothing ot help them stop.
This is why a doctor won't tell his patient: "stop FOO". Instead, they might nudge him with information. Respecting the patients knowledge and struggle, a doctor is understanding, supporting and able to connect with others who have successfully "stopped FOO".
A good doctor understands that an eating disorder is part of a complex, intertwined and difficult to understand network of causes and effects. Helping the patient understand the complexity of the situation is often the first step towards a permanent solution.
A good doctor understands that an eating disorder is part of a complex, intertwined and difficult to understand network of causes and effects. Helping the patient understand the complexity of the situation is often the first step towards a permanent solution.
Yes, I agree. Some people in this thread don't, and are saying that merely telling someone that smoking is harmful is enough to make that person stop smoking.
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> Fat people know they're fat.
Many don't. Or they don't blame overeating. It's always "genetics" or "metabolism". Not just plain old overeating.
Many don't. Or they don't blame overeating. It's always "genetics" or "metabolism". Not just plain old overeating.
Sure, but even for those people merely telling them they're fat, and that they're fat because they eat the wrong food will do nothing to stop them from being fat.
> will do nothing to stop them from being fat.
I disagree with one point. It puts things into their control, rather than out of their control.
If the doctor says you're fat because your metabolism is low, or you're big boned, you can shrug it off and say "Well, there's nothing I can do about it, might as well not try."
If the doctor says you're fat because you eat too much food, you can do the same thing, but then at least the ball is in your court. You are fat because of your actions, and it's theoretically possible to change your actions, but it's definitely not possible to change your genetics or metabolism.
I disagree with one point. It puts things into their control, rather than out of their control.
If the doctor says you're fat because your metabolism is low, or you're big boned, you can shrug it off and say "Well, there's nothing I can do about it, might as well not try."
If the doctor says you're fat because you eat too much food, you can do the same thing, but then at least the ball is in your court. You are fat because of your actions, and it's theoretically possible to change your actions, but it's definitely not possible to change your genetics or metabolism.
TIL mental health problems go away if you tell sufferers to just get better.
This isn't House, M.D. The doctor's job is to assist to a great degree in fixing the problem, not just figuring out what the problem was.
Or have a doctor tell you to stop engaging in risky sexual activity?
It's self-destructive behavior just like overeating.
It's self-destructive behavior just like overeating.
If that certainly _is_ true, that's a multi-million dollar chaching for the ADA and the ACLU. Also, if I was working for CVS I'd have my lawyer on that like flies on rice for a number of slippery slope reasons. That fires me up a ton, because if let's say the FitBit tracker they give you requires login, they might do the setup for you and slap it on your wrist. Well, that information contains monitoring and GPS coordinates and what is the policy around that? What is the retention of data? What is the sharing of data policy? I mean CVS case really raises an eyebrow for me.
"The national drugstore chain CVS announced in 2013 that it would require employees to report their levels of body fat, blood sugar, blood pressure, and cholesterol — or pay $600 a year."
"The national drugstore chain CVS announced in 2013 that it would require employees to report their levels of body fat, blood sugar, blood pressure, and cholesterol — or pay $600 a year."
In the long run these corporate solutions are what is needed. Why? Because currently there is no financial incentive, in the short term, to stay healthy. Health insurance costs continue to increase and adverse selection continually makes this worse.
The bias in this article is disturbing because currently even the government is doing nothing to incentive people financially in the short term in this same way. Think 50 years down the line - if systems like this aren't in place we are in serious trouble. There is no perfect solution but to blame companies for tying health and its costs to short term costs is insane. This is a GOOD THING. Wake up people!
This reminds me of a quote (paraphrasing). "The market is the worst form of economic distribution, except for all others."
The bias in this article is disturbing because currently even the government is doing nothing to incentive people financially in the short term in this same way. Think 50 years down the line - if systems like this aren't in place we are in serious trouble. There is no perfect solution but to blame companies for tying health and its costs to short term costs is insane. This is a GOOD THING. Wake up people!
This reminds me of a quote (paraphrasing). "The market is the worst form of economic distribution, except for all others."
> This reminds me of a quote (paraphrasing). "The market is the worst form of economic distribution, except for all others."
Yeah, let's ignore all that has been done in Europe in terms of health, which did not involve markets but did work in practice.
Us being rich, it's much more pleasant to financially harass the poor, rather than doing stuff like public health care, a preventive medical policy, or a real education system which would cost money to us, but would have a real impact.
Yeah, let's ignore all that has been done in Europe in terms of health, which did not involve markets but did work in practice.
Us being rich, it's much more pleasant to financially harass the poor, rather than doing stuff like public health care, a preventive medical policy, or a real education system which would cost money to us, but would have a real impact.
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... except that the market for health services is anything but healthy in the US. That's BTW also a major reason for the exploding cost of the health care - the lack of personal short term incentives isn't.
It sounds like you are agreeing with me not disagreeing... This is a short term incentive. That's why the bias here is disturbing!
I do not agree with your views. Apologies if I did not make myself clear here -- English is not my first language (or second.. or even third...)
Let me try to reword then:
1. Free market is NOT an appropriate solution for healthcare. There are plenty of reasons for this (assymetry of information, natural monopolies etc)
2. We can argue whether the US healthcare system is based on free market principles or not. It's exploding cost is however NOT driven by the lack of short-term personal incentives, but by the failure to link the amount billed to the true cost of the service rendered.
3. Every bill from a doctor you see is a very clear short-term incentive for keeping yourself healthy -- clearly more so than a $50 discount on your monthly insurance payment.
Let me try to reword then:
1. Free market is NOT an appropriate solution for healthcare. There are plenty of reasons for this (assymetry of information, natural monopolies etc)
2. We can argue whether the US healthcare system is based on free market principles or not. It's exploding cost is however NOT driven by the lack of short-term personal incentives, but by the failure to link the amount billed to the true cost of the service rendered.
3. Every bill from a doctor you see is a very clear short-term incentive for keeping yourself healthy -- clearly more so than a $50 discount on your monthly insurance payment.
> 1. Free market is NOT an appropriate solution for healthcare. There are plenty of reasons for this (assymetry of information, natural monopolies etc)
Also:
* The free market distributes goods based on ability to pay; it's wrong to deny people health care based on their wealth.
* The free market requires failures of businesses and services; that is not acceptable when people's health is involved. It's ok that the solution to bad casual gaming software vendors is that their customers are screwed and they go out of business. That's not ok for bad doctors, drugs, hospitals, etc.
Also:
* The free market distributes goods based on ability to pay; it's wrong to deny people health care based on their wealth.
* The free market requires failures of businesses and services; that is not acceptable when people's health is involved. It's ok that the solution to bad casual gaming software vendors is that their customers are screwed and they go out of business. That's not ok for bad doctors, drugs, hospitals, etc.
I agree with both, but these are normative statements, expressing what one expects to be right or moral. As these are based on belief systems, they may not be convincing to some of us in the forum.
There's plenty of positive reasons explaining why free market is NOT the right solution for health care, essentially boiling down to distorted incentives which lead to sub-optimal solutions.
There's plenty of positive reasons explaining why free market is NOT the right solution for health care, essentially boiling down to distorted incentives which lead to sub-optimal solutions.
I see the distinction, but as an important aside ...
> these are normative statements, expressing what one expects to be right or moral. As these are based on belief systems, they may not be convincing to some of us in the forum.
While I respect that people have varying moral beliefs, many much different than mine, I don't believe that morals are infinitely relative and any belief is possible or acceptable. It's sort of the new political correctness, never to discuss morality, assume it, or argue for it. I think there are some pretty universal, natural morals; morals aren't artificial constructs and amoral people aren't normal or common, they are ill and called sociopaths.
Yes, there are among our 7 billion fellow humans some that believe people should be left to die at the hospital door because they can't afford care, but it's so few that I don't have to take them into account. More might argue it theoretically, but if someone was dying in front of them they would be horrified and help.
> these are normative statements, expressing what one expects to be right or moral. As these are based on belief systems, they may not be convincing to some of us in the forum.
While I respect that people have varying moral beliefs, many much different than mine, I don't believe that morals are infinitely relative and any belief is possible or acceptable. It's sort of the new political correctness, never to discuss morality, assume it, or argue for it. I think there are some pretty universal, natural morals; morals aren't artificial constructs and amoral people aren't normal or common, they are ill and called sociopaths.
Yes, there are among our 7 billion fellow humans some that believe people should be left to die at the hospital door because they can't afford care, but it's so few that I don't have to take them into account. More might argue it theoretically, but if someone was dying in front of them they would be horrified and help.
> Yes, there are among our 7 billion fellow humans some that believe people should be left to die at the hospital door because they can't afford care,
Wow, strawman argument much? What if they're dying of an acute cancer that requires a million dollar treament? A treatment that could provide food or medical treatment for thousands of other people?
What if they were dying of some incurable disease and would simply take up a hospital bed for no use?
You seem to think of costs as floating in a vaccum, rather than a redistributive method for limited resources.
Wow, strawman argument much? What if they're dying of an acute cancer that requires a million dollar treament? A treatment that could provide food or medical treatment for thousands of other people?
What if they were dying of some incurable disease and would simply take up a hospital bed for no use?
You seem to think of costs as floating in a vaccum, rather than a redistributive method for limited resources.
Complete inelasticity of demand and lack of the ability for consumers to inform themselves (read: I will never understand the finer points of organ transplantation or be able to assess value for money) are two very factual ECON101 reasons.
> it's wrong to deny people health care based on their wealth.
Why? There are certain heroic attempts that are not economically feasible to attempt unless you're incredibly wealthy.
Is the government responsible for funding extremely expensive treatments at the cost of denying health care/food subsidies for many other people who happen to be in need?
Once you start making absolute statements like that, you can justify any atrocity on the altar of your absolute right.
Why? There are certain heroic attempts that are not economically feasible to attempt unless you're incredibly wealthy.
Is the government responsible for funding extremely expensive treatments at the cost of denying health care/food subsidies for many other people who happen to be in need?
Once you start making absolute statements like that, you can justify any atrocity on the altar of your absolute right.
All those arguments also apply to food production. But that's a free market, and does rather well.
(Yes, I know there are agricultural subsidies. It's not a perfect free market.)
(Yes, I know there are agricultural subsidies. It's not a perfect free market.)
It's true that there's no shortage of food. In fact we're throwing away more than enough food to feed everyone in the country, around half the food that we produce. That's not very efficient.
Meanwhile we stigmatize people who need food assistance, make them jump through bureaucratic hoops designed to demoralize and suppress them, demand that they present proof that their children deserve to not starve, even while incentivizing them to remain in need of food assistance. That's not very effective.
So food production isn't doing 'rather well' yet, more like 'almost acceptable but needs work'. (Still much better than it was a century or two ago.)
Meanwhile we stigmatize people who need food assistance, make them jump through bureaucratic hoops designed to demoralize and suppress them, demand that they present proof that their children deserve to not starve, even while incentivizing them to remain in need of food assistance. That's not very effective.
So food production isn't doing 'rather well' yet, more like 'almost acceptable but needs work'. (Still much better than it was a century or two ago.)
It's doing very well indeed if you compare it to any other system tried for producing food. It is still experiencing price declines (unlike health care). For example, steak was a luxury when I was a kid. Now, it's cheap as dirt at $6.99 a pound.
I'll take its imperfections any day over the gaping holes and incredible costs in the not-so-free-market health care system.
I'll take its imperfections any day over the gaping holes and incredible costs in the not-so-free-market health care system.
A lot of the cheapness of food is coming from using natural resources at an unsustainable rate, like draining the Ogallala Aquifer at far beyond its replenishment rate. I'd call that more along the lines of kicking the problems along for someone in the future to deal with all at once and not "doing very well"
The spectre of famine ended in the US around 1800 with free market agriculture, long before anyone heard of the Ogallala Aquifer. It also ended for every other country that adopted free market agriculture.
Non-free market agriculture, on the other hand, has a pretty sorry historical record with no evidence that it was more sustainable or equitable.
Non-free market agriculture, on the other hand, has a pretty sorry historical record with no evidence that it was more sustainable or equitable.
US food production is decidedly non free market with the amount of subsidies the industry gets.
Additionaly, you can say the system is working great now, but if it's only doing so by pushing off externalities in an unsustainable way into the future in a forseeable manner, that does not mean the system is doing a great job
Additionaly, you can say the system is working great now, but if it's only doing so by pushing off externalities in an unsustainable way into the future in a forseeable manner, that does not mean the system is doing a great job
> The spectre of famine ended in the US around 1800 with free market agriculture
I'm not sure how you define "famine", but many people have been malnourished since; some are right now AFAIK. Think of the Great Depression, for example, for a much greater scale problem. I would bet some have starved.
But most of all, any research you have would be appreciated; I feel like everyone, including me, is a bit naked out here.
I'm not sure how you define "famine", but many people have been malnourished since; some are right now AFAIK. Think of the Great Depression, for example, for a much greater scale problem. I would bet some have starved.
But most of all, any research you have would be appreciated; I feel like everyone, including me, is a bit naked out here.
One objective way is to look at average height, which increased throughout the 19th century in the US, and increased in other countries when they adopted free market agriculture. Height is a good proxy for having sufficient nutritious food.
> cheap as dirt at $6.99 a pound
Cheap for most people reading HN, but unaffordable for many.
> It's doing very well indeed if you compare it to any other system tried for producing food
Yes for producing (AFAIK) but not for distributing. I believe, but have no research to back it up, that countries with better social safety nets have less malnourishment than the U.S.
Cheap for most people reading HN, but unaffordable for many.
> It's doing very well indeed if you compare it to any other system tried for producing food
Yes for producing (AFAIK) but not for distributing. I believe, but have no research to back it up, that countries with better social safety nets have less malnourishment than the U.S.
The USDA recommendation for a healthy amount of beef per day is 5-6 ounces. That's about $2.25 per day. Heck, a pound of apples cost more than that. A loaf of bread costs more than that. $6.99 is the regular price, too - it's often on sale as it nears its expiration date.
How cheap does it have to be before it is successful?
How cheap does it have to be before it is successful?
> How cheap does it have to be before it is successful?
A good question, but the fact is that many cannot afford sufficient food. A quick search turned up this article from 2014 at the top (and many others too):
Hunger in America: 1 in 7 rely on food banks
http://www.usatoday.com/story/news/nation/2014/08/17/hunger-...
1 in 7 Americans is around 45 million people (I know that's taking the headline at face value, but clearly there are many people who need it).
A good question, but the fact is that many cannot afford sufficient food. A quick search turned up this article from 2014 at the top (and many others too):
Hunger in America: 1 in 7 rely on food banks
http://www.usatoday.com/story/news/nation/2014/08/17/hunger-...
1 in 7 Americans is around 45 million people (I know that's taking the headline at face value, but clearly there are many people who need it).
If they're getting fed by a food bank, then they are getting fed.
Making steak cheaper than it already is isn't going to make any difference.
Making steak cheaper than it already is isn't going to make any difference.
> All those arguments also apply to food production. But that's a free market, and does rather well.
I disagree; it does poorly:
Poor people in the U.S., the richest country in the history of the world, need subsidies (such as food stamps) to have enough to eat, and even then often can't afford healthy food. I read awhile ago that over 50% of children in U.S. public schools needed subsidized lunches (but my memory is hazy, so it might be that over 50% came from families that used food stamps or something similar; sorry I'm too lazy to look it up).
Despite there being enough food and money in the world to feed everyone, people still starve and others are malnourished in many places. At least some researchers attribute the Arab Spring to increased food prices, as a proxy indicator of the impact (again, too busy to look up the data).
> Yes, I know there are agricultural subsidies. It's not a perfect free market.
Agreed, and there are other distortions besides agricultural subsidies, esp. when it comes to international trade. I don't know enough about that market to characterize it.
I disagree; it does poorly:
Poor people in the U.S., the richest country in the history of the world, need subsidies (such as food stamps) to have enough to eat, and even then often can't afford healthy food. I read awhile ago that over 50% of children in U.S. public schools needed subsidized lunches (but my memory is hazy, so it might be that over 50% came from families that used food stamps or something similar; sorry I'm too lazy to look it up).
Despite there being enough food and money in the world to feed everyone, people still starve and others are malnourished in many places. At least some researchers attribute the Arab Spring to increased food prices, as a proxy indicator of the impact (again, too busy to look up the data).
> Yes, I know there are agricultural subsidies. It's not a perfect free market.
Agreed, and there are other distortions besides agricultural subsidies, esp. when it comes to international trade. I don't know enough about that market to characterize it.
Food could be free and there'd still be malnourishment. It's necessary to look at a bigger picture when looking at the overall performance.
> Food could be free and there'd still be malnourishment. It's necessary to look at a bigger picture when looking at the overall performance.
Hmmm ...
I'm talking about the whole economic system of production and distribution, the 'free market' (or whatever it is), so I agree with the second statement - I wouldn't throw the whole thing out, but it needs to be supplemented. It doesn't seem like much defense of the current system that radically changing one element of it, the price, won't achieve a perfect outcome (and I frankly doubt you mean it that way but I don't want to speak for you).
You seem strongly attached to the free market concept - what if another system worked better? What's more important, the people or the economic system which feeds them?
To be fair: I strongly support a 'free market' as a great tool for a great many use cases, but it's not a universal tool or panacea and it's not the goal; it's merely the means - my favorite one in the toolbox.
----
Happy New Year Walter!
Hmmm ...
I'm talking about the whole economic system of production and distribution, the 'free market' (or whatever it is), so I agree with the second statement - I wouldn't throw the whole thing out, but it needs to be supplemented. It doesn't seem like much defense of the current system that radically changing one element of it, the price, won't achieve a perfect outcome (and I frankly doubt you mean it that way but I don't want to speak for you).
You seem strongly attached to the free market concept - what if another system worked better? What's more important, the people or the economic system which feeds them?
To be fair: I strongly support a 'free market' as a great tool for a great many use cases, but it's not a universal tool or panacea and it's not the goal; it's merely the means - my favorite one in the toolbox.
----
Happy New Year Walter!
> You seem strongly attached to the free market concept - what if another system worked better?
None has yet, not even close. And it's not for lack of trying other systems. Me, I'm familiar enough with history to be disinterested in trying other schemes and risking mass starvation.
Keep in mind that Kansas in the 80s was known as the "Breadbasket of the Soviet Union". See "Ronald Reagan" by Broussard.
None has yet, not even close. And it's not for lack of trying other systems. Me, I'm familiar enough with history to be disinterested in trying other schemes and risking mass starvation.
Keep in mind that Kansas in the 80s was known as the "Breadbasket of the Soviet Union". See "Ronald Reagan" by Broussard.
You didn't answer the question - not that you are on the witness stand, of course.
Many, maybe not you, seem to be much more interested in the ideology and forget about the people. There is not much interest in the 'details' - serious questions about, and thought and attention to, how real people are really faring. Some even sacrifice real people to their ideology; they defend the ideology at all costs, not the people.
Many, maybe not you, seem to be much more interested in the ideology and forget about the people. There is not much interest in the 'details' - serious questions about, and thought and attention to, how real people are really faring. Some even sacrifice real people to their ideology; they defend the ideology at all costs, not the people.
> Every bill from a doctor you see is a very clear short-term incentive for keeping yourself healthy -- clearly more so than a $50 discount on your monthly insurance payment.
It's also an incentive to avoid going to the doctor unless you really need to. Something that I'm not sure helps with healthcare costs in the long run.
It's also an incentive to avoid going to the doctor unless you really need to. Something that I'm not sure helps with healthcare costs in the long run.
There's already a health incentive to stay healthy, by definition. If people won't obey a health incentive, why will they obey a financial incentive?
And there's already a financial incentive as well: Discrimination provides a financial advantage to people who appear more healthy (younger, thinner, taller).
And there's already a financial incentive as well: Discrimination provides a financial advantage to people who appear more healthy (younger, thinner, taller).
I disagree with OP point... but I also disagree with yours.
For example, in the new year eve, my parents asked me my objective for 2017, I told them to become strong and healthy.
Both of them were VERY skeptical, and thought it was absurd, specially because in their view, being strong and healthy won't make me pay my bills...
And they are in a way, correct, to stay healthy you need resources and time, not always those are available, for example right now I am unemployed and have no contract, I have plenty of time, but no resources, and I am begging my parents to buy me some gymnastic rings I need for my exercises... but short term, I would be better if I stopped worrying for my health and went to get some short term job, even one blatantly unhealthy one (for example working with garbage).
The thing is, I chased money (Because I was in debt) disregarding my health (out of necessity) from my 18 years until I was about 27 or 28... It is clear now the long term cost has been very, very high, my health is very damaged, yet if I had to go back, I don't think what I could have done differently, the path I took was the only path available to pay my debts, and in my country personal bankruptcy doesn't exist, not paying my debts wouldn't work.
For example, in the new year eve, my parents asked me my objective for 2017, I told them to become strong and healthy.
Both of them were VERY skeptical, and thought it was absurd, specially because in their view, being strong and healthy won't make me pay my bills...
And they are in a way, correct, to stay healthy you need resources and time, not always those are available, for example right now I am unemployed and have no contract, I have plenty of time, but no resources, and I am begging my parents to buy me some gymnastic rings I need for my exercises... but short term, I would be better if I stopped worrying for my health and went to get some short term job, even one blatantly unhealthy one (for example working with garbage).
The thing is, I chased money (Because I was in debt) disregarding my health (out of necessity) from my 18 years until I was about 27 or 28... It is clear now the long term cost has been very, very high, my health is very damaged, yet if I had to go back, I don't think what I could have done differently, the path I took was the only path available to pay my debts, and in my country personal bankruptcy doesn't exist, not paying my debts wouldn't work.
Staying healthy is a really long term goal. You need to do it every day but there's no immediate penalty for not being healthy on a day to day basis. Penalizing someone financially is much more real and tangible than "that pizza you ate today is contributing very slightly to your degrading health"
That sounds plausible, but on the other hand, it also sounds plausible that the immediate discomfort of dieting for most people would outweigh the immediate financial incentive.
An additional plausible explanation, that always has to be considered until it's eliminated, is that wellness reward programs don't work at all, but tap into the psychology of the HR managers who buy that kind of stuff.
I was only thinking in terms of a simplistic "homo economicus" model, in which a worker acts rationally in their own best interest. If we abandon that model, I'm not sure we have a useful alternative.
An additional plausible explanation, that always has to be considered until it's eliminated, is that wellness reward programs don't work at all, but tap into the psychology of the HR managers who buy that kind of stuff.
I was only thinking in terms of a simplistic "homo economicus" model, in which a worker acts rationally in their own best interest. If we abandon that model, I'm not sure we have a useful alternative.
The better way to tackle that problem is to turn the incentives around in the US health sector, which currently runs on a piece rate model, which rewards the medical professions for finding as meany treatments as possible to deliver to the population as long as possible. Give them a flat rate percentage of GDP per patient, and motivate them to reduce the amount of work they do, by keeping everybody healthy, and you'd have a much better system.
Yes!!! And since this isn't happening how is what innovative corporations are doing a bad thing?
It's embarrassing for the US government that they can't find other methods for short term incentives and the private sector is stepping up here.
It's embarrassing for the US government that they can't find other methods for short term incentives and the private sector is stepping up here.
Not all increases in health care costs are bad. When we learn how to treat new diseases or conditions, that's good, even if it costs money.
[deleted]
Im so healthy my doctor told me I need to drink more and consume more salt. I don't need HR knowing anything about my health. F them and F crypto-fascists who argue this is a good thing.
You have a choice!!! Why are more short term incentives that are clearly lacking in the market a bad thing?!?!?!
Because it MY data. It's voluntary now, but will it always be?
You're a free market guy. What would you say about insurance companies deciding they'll only cover people who release all their data to them.
Now I don't have a choice to release my data, do I? (since I'm forced to have insurance)
How do I know what my doctor does with my electronic data? Legally, I have some assurances. Except we now know how much these legal assurances are in the electronic domain.
This is soft paternalism. Freedom is being able to smoke a cigarette in your car with your 2 mo. old daughter in the back waving your middle finger at any holier-than-thou puritan who has a problem with it.
You're a free market guy. What would you say about insurance companies deciding they'll only cover people who release all their data to them.
Now I don't have a choice to release my data, do I? (since I'm forced to have insurance)
How do I know what my doctor does with my electronic data? Legally, I have some assurances. Except we now know how much these legal assurances are in the electronic domain.
This is soft paternalism. Freedom is being able to smoke a cigarette in your car with your 2 mo. old daughter in the back waving your middle finger at any holier-than-thou puritan who has a problem with it.
The free market solution is different tiers of service that offer different qualities.
Health care is tech which means it advances very quickly. It's illegal in the US to get the top tier service of 20 years ago (the only option is the best care right now).
If I were you I would simply choose a lower tier service that is still nearly state of the art. Because the top tier is so expense you must share your data but the lower tier services is 95% as good for much lower cost.
Look at literally every other industry to see how this is true - you have quality choices and its amazing and a beautiful thing. OR, get health care in say India.
Cliffs: You don't have a choice in health care quality and since that's unsustainable corporations are also reducing choices when it comes to privacy.
Health care is tech which means it advances very quickly. It's illegal in the US to get the top tier service of 20 years ago (the only option is the best care right now).
If I were you I would simply choose a lower tier service that is still nearly state of the art. Because the top tier is so expense you must share your data but the lower tier services is 95% as good for much lower cost.
Look at literally every other industry to see how this is true - you have quality choices and its amazing and a beautiful thing. OR, get health care in say India.
Cliffs: You don't have a choice in health care quality and since that's unsustainable corporations are also reducing choices when it comes to privacy.
> Those who don’t reach the targets in three categories have to pay an extra $1,000 a year toward their health insurance.
It sounds a lot less sinister if you rephrase it:
And those who reach targets in three categories get an extra $1,000 on their paycheck, that comes from the discount on their health insurance.
This kind of data should not be known/tracked by your employer ever, for reasons of privacy. That's totally different from your health plan knowing, however.
The deep question here, regarding all health insurance (including national schemes), is -- to what extent should you be expected to subsidize other people's intentionally unhealthy life choices? To what extent should people who make these unhealthy choices be forced to pay more for them? If I get diabetes because I drank 20 cokes a day...
But it gets even harder, because who defines healthy? The long-term effects of so many activities is so unclear, or under so much debate -- just like sugar, for example.
It sounds a lot less sinister if you rephrase it:
And those who reach targets in three categories get an extra $1,000 on their paycheck, that comes from the discount on their health insurance.
This kind of data should not be known/tracked by your employer ever, for reasons of privacy. That's totally different from your health plan knowing, however.
The deep question here, regarding all health insurance (including national schemes), is -- to what extent should you be expected to subsidize other people's intentionally unhealthy life choices? To what extent should people who make these unhealthy choices be forced to pay more for them? If I get diabetes because I drank 20 cokes a day...
But it gets even harder, because who defines healthy? The long-term effects of so many activities is so unclear, or under so much debate -- just like sugar, for example.
Subsidising other people's unhealthy choices is clearly going to be a controversial topic, but I've come to the conclusion that the only sensible approach is to ignore the choices and threat the condition.
Firstly, it's pretty hard to measure the choices people have made. Any attempt at measurement is going to add extra costs for little or no benefit.
Secondly, we're judging people on things where we don't know the complete story. If a single parent is eating unhealthily and not exercising because they are short on both money and time, that's hardly something to make them pay for. If someone's been addicted to cigarettes for 20 years, they have probably tried and failed to give them up. To me treating wealthy people's skiing injuries should be at least as controversial as treating poor people's smoking-related problems. Personally I like to run to keep fit, but I view that as good fortune - I'm lucky that I'm healthy enough to run and that I enjoy it, and that I have time to do it.
Finally if someone gets diabetes after drinking 20 cokes a day, they're definitely paying for that decision even without a financial penalty.
In summary I guess that I feel that good health is a very fortunate thing to have, and I certainly don't feel entitled to extra cash for my good luck.
The question here is as to whether this $1000 bonus/penalty changes behaviour or just rewards those who are naturally healthy/enjoy sport/like healthy food.
Firstly, it's pretty hard to measure the choices people have made. Any attempt at measurement is going to add extra costs for little or no benefit.
Secondly, we're judging people on things where we don't know the complete story. If a single parent is eating unhealthily and not exercising because they are short on both money and time, that's hardly something to make them pay for. If someone's been addicted to cigarettes for 20 years, they have probably tried and failed to give them up. To me treating wealthy people's skiing injuries should be at least as controversial as treating poor people's smoking-related problems. Personally I like to run to keep fit, but I view that as good fortune - I'm lucky that I'm healthy enough to run and that I enjoy it, and that I have time to do it.
Finally if someone gets diabetes after drinking 20 cokes a day, they're definitely paying for that decision even without a financial penalty.
In summary I guess that I feel that good health is a very fortunate thing to have, and I certainly don't feel entitled to extra cash for my good luck.
The question here is as to whether this $1000 bonus/penalty changes behaviour or just rewards those who are naturally healthy/enjoy sport/like healthy food.
Seconded!
Being "healthy" is the realization of two interacting random processes: things that are in your control and things that are not. The tricky part is that the division between these categories is really fuzzy and markedly different for everyone.
The link between cause and effect is also likely less simple than wellness models predict. Started running? You might feel good now but not realize that you're exacerbating the arthritis your genetics predisposes you to in 20 years. Stopped smoking? Awesome! But why did your employer put you in a state of constant chronic stress for 10 years resulting in elevated cortisol that resulted in a stroke?
The path between cause and effect is very difficult if not practically impossible to trace out for populations. So although wellness programs are not as sinister as some believe, they definitely are not as nice or positive as they present themselves, either.
Being "healthy" is the realization of two interacting random processes: things that are in your control and things that are not. The tricky part is that the division between these categories is really fuzzy and markedly different for everyone.
The link between cause and effect is also likely less simple than wellness models predict. Started running? You might feel good now but not realize that you're exacerbating the arthritis your genetics predisposes you to in 20 years. Stopped smoking? Awesome! But why did your employer put you in a state of constant chronic stress for 10 years resulting in elevated cortisol that resulted in a stroke?
The path between cause and effect is very difficult if not practically impossible to trace out for populations. So although wellness programs are not as sinister as some believe, they definitely are not as nice or positive as they present themselves, either.
I think lot of people see being overweight is a moral failure and want to punish people for it. That's all there is to it, no matter how cleverly worded it can be about "being healthy" and "subsidizing" and "choices".
The reason such programs are becoming more common is because they are becoming cheaper. Given that, how can you be certain that the cost is exceeding the benefits (as you claim)? How low would the costs/how high the benefits before you changed your position on this?
To me treating wealthy people's skiing injuries should be at least as controversial as treating poor people's smoking-related problems.
The former is paid for by the wealthy person, the latter by society. The poor person is directly harming me by smoking. It's perfectly reasonable to criticize the poor person in this case. Similarly, one might criticize a polluter (who harms us all), but not criticize people who have gay sex in the privacy of their own home (harming no one).
Think of it as shared responsibility - the rich are responsible for paying, the poor can reasonably be held responsible for other things.
To me treating wealthy people's skiing injuries should be at least as controversial as treating poor people's smoking-related problems.
The former is paid for by the wealthy person, the latter by society. The poor person is directly harming me by smoking. It's perfectly reasonable to criticize the poor person in this case. Similarly, one might criticize a polluter (who harms us all), but not criticize people who have gay sex in the privacy of their own home (harming no one).
Think of it as shared responsibility - the rich are responsible for paying, the poor can reasonably be held responsible for other things.
> The former is paid for by the wealthy person, the latter by society.
How so? Both are paid for by an insurance pool. Unless the skier is paying a higher insurance premium for the extra risk that they are incurring by skiing, they are not paying for their skiing injuries.
How so? Both are paid for by an insurance pool. Unless the skier is paying a higher insurance premium for the extra risk that they are incurring by skiing, they are not paying for their skiing injuries.
Most poor people have insurance which is paid for by the rich.
If insurance companies start to charge skiiers their actuarial cost, I have no problem with this. If they don't I suspect it's simply because there aren't very many.
If insurance companies start to charge skiiers their actuarial cost, I have no problem with this. If they don't I suspect it's simply because there aren't very many.
I have a somewhat more practical objection - when you reduce their pay, how are these people supposed to get healthy again? Achieving healthy status seems more costly than maintaining it, but with this system, if you fall behind, your resources are further reduced on top of you being physically worse, making it even harder to get back to being healthy. It's like Mario Kart without blue shells.
This is how punishments work in general. They don't help people - they just weed people out.
> It's like Mario Kart without blue shells.
good analogy
good analogy
Except it's not a cut for people who don't follow. It's a bonus for those that do. Anyone can get the bonus, just do the dance.
Huh? Surely you understand that there's no difference between calling something a "cut" or a "bonus" when the result is the same?
Perception my friend. Perception is everything.
We give a tax cut to people with kids to encourage families in the US. How would people react if we changed it to a no-kid penalty paid by all people without children? Same thing right? But we would react very different to it.
We give a tax cut to people with kids to encourage families in the US. How would people react if we changed it to a no-kid penalty paid by all people without children? Same thing right? But we would react very different to it.
This is a glass half empty, half full argument. Honestly, I am taking the view that "wellness programs" should be mandatory fun. Why? Just look at social programs like social security, garbage collection, public schools, welfare ... I mean we all pay into a system even when we are healthy, wealthy, and happy .. but there comes a time, when we won't be. The buy in ideology here, is what is good for the goose is good for the gander. Healthcare costs are rising for every company out there. It's _not_ free. When someone joins a wellness program they are doing so for a benefit. But .. as a company it is insuring that people are doing their best to keep the social healthcare system that the company purchased costs down for everyone. You are doing this for your fellow co-workers, not you. It's being caring enough to say hey .. I'm working hard to keep myself in the best shape I can, so I don't have to die and cost our company money when they negotiation on the bulk for ALL of us. This is not a company thing, it's a fellow-man thing. This is about as close to universal healthcare as you are going to see and it's a good thing.
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Eating less costs less. Burpees are free.
There is an entire subreddit dedicated to eating cheap and healthy: https://www.reddit.com/r/EatCheapAndHealthy/
You don't need a gym, even to get into seriously good shape https://www.reddit.com/r/bodyweightfitness/
There is no fixed pie here, there only question is if you want it or not.
There is an entire subreddit dedicated to eating cheap and healthy: https://www.reddit.com/r/EatCheapAndHealthy/
You don't need a gym, even to get into seriously good shape https://www.reddit.com/r/bodyweightfitness/
There is no fixed pie here, there only question is if you want it or not.
And time and energy are infinite, right.
It doesn't take more time to eat less, but for exercise it is simply a question of priority. Yes you will have to find some part of your day where you do something you value less, then take the time to exercise instead of doing that.
It's great that you have the privilege of sufficient spare time to allocate towards exercise and the luck to avoid any conflicting medical problems. Investing in your own health with regular exercise and an improved diet will hopefully lead to fewer problems later in life.
However, please remember that some people are not as privileged. Free time is not always available. Good food - and sufficient time to prepare it - isn't always available either. Life is complicated and work, kids, and other important obligations take priority for many people.
> Eating less costs less.
Eating less doesn't always lead to better health. Nutrition is complicated.
> there only question is if you want it or not.
Do you also tell people with a broken leg that they could walk if the wanted to? Staying healthy is not a matter of willpower and/or education. Staying healthy isn't even deterministic, because our knowledge of medicine, nutrition, etc is still imperfect.
However, please remember that some people are not as privileged. Free time is not always available. Good food - and sufficient time to prepare it - isn't always available either. Life is complicated and work, kids, and other important obligations take priority for many people.
> Eating less costs less.
Eating less doesn't always lead to better health. Nutrition is complicated.
> there only question is if you want it or not.
Do you also tell people with a broken leg that they could walk if the wanted to? Staying healthy is not a matter of willpower and/or education. Staying healthy isn't even deterministic, because our knowledge of medicine, nutrition, etc is still imperfect.
> You don't need a gym, even to get into seriously good shape https://www.reddit.com/r/bodyweightfitness/
/r/bodyweightfitness is actually pretty hostile to low/no-equipment approaches. It should tell you something that the top comment on a "Jail for 3 years - training with no equipment" post leads with "you might have access to a gym".
/r/bodyweightfitness is actually pretty hostile to low/no-equipment approaches. It should tell you something that the top comment on a "Jail for 3 years - training with no equipment" post leads with "you might have access to a gym".
> It sounds a lot less sinister if you rephrase it
A little voice inside me keeps repeating that it will not be like that in the long run. They will start saying it's a bonus, but years after years, it will transform into a malus in the calculations, like they always do.
> But it gets even harder, because who defines healthy?
+10. And the more you dig into health, the more you realize health professionals don't always have the best informations as you though they would. It's worth to take time to try many things on your own in parallel of traditional advices otherwise you can miss so many good practices, or engage in so bad ones.
A little voice inside me keeps repeating that it will not be like that in the long run. They will start saying it's a bonus, but years after years, it will transform into a malus in the calculations, like they always do.
> But it gets even harder, because who defines healthy?
+10. And the more you dig into health, the more you realize health professionals don't always have the best informations as you though they would. It's worth to take time to try many things on your own in parallel of traditional advices otherwise you can miss so many good practices, or engage in so bad ones.
> subsidize other people's intentionally unhealthy life choices
Person's health depends not only on their choices. Some people are born more healthy and some are less. So does it mean that if somebody has errors in their DNA they should get less salary?
It would be more fair just to make a tax for alcohol and cigarettes.
Person's health depends not only on their choices. Some people are born more healthy and some are less. So does it mean that if somebody has errors in their DNA they should get less salary?
It would be more fair just to make a tax for alcohol and cigarettes.
As someone who works at a company that is removing all vending machines at the first week of the year, I agree. It's none of their damn business what people eat or drink and taking vending machines out just reduces employee morale.
> none of their damn business what people eat or drink
Well if they're buying the food and drink and providing it to their employees then it's literally part of their business operations.
Well if they're buying the food and drink and providing it to their employees then it's literally part of their business operations.
They are not buying food and drink - a third party installs vending machines on site and actually pays the business to do so.
I'm not sure that a minor business indirection like that really makes a material difference to what we're discussing.
They're still providing a service to their employees as part of their business operations. People are talking about this like having cans of drinks is some kind of human right that they're entitled to. I'm arguing that it's a business decision and totally up to the employer. There aren't any laws, or I'm arguing any moral imperatives, that means they have to offer you any particular drinks.
They're still providing a service to their employees as part of their business operations. People are talking about this like having cans of drinks is some kind of human right that they're entitled to. I'm arguing that it's a business decision and totally up to the employer. There aren't any laws, or I'm arguing any moral imperatives, that means they have to offer you any particular drinks.
It's not their duty to regulate the private dietary choices of every individual.
I don't think anyone in this thread argued that it was their duty to do anything. Everything we've talked about employers doing in this thread has been optional for the the employer. So you haven't said anything that anyone appears to disagree with.
But I wouldn't say it was regulating. Can you see a difference between being allowed to eat and drink whatever you want, and requiring that your employer provide whatever you want to eat and drink?
If your local shop doesn't happen to sell your favourite drink they aren't regulating you are they? That's just not what that word means.
But I wouldn't say it was regulating. Can you see a difference between being allowed to eat and drink whatever you want, and requiring that your employer provide whatever you want to eat and drink?
If your local shop doesn't happen to sell your favourite drink they aren't regulating you are they? That's just not what that word means.
I agree with that, but it's also not their duty to supply easy access to shitty unhealthy food either.
But they aren't. They are giving a bonus to people that make good choices. Seems good to me.
Disclaimer: makes good choices and am health nut.
Disclaimer: makes good choices and am health nut.
Why do you think other people don't make the same good choices?
I am at Walmart right now. I looked around.
Other Americans do not make the same good choices I make.
Other Americans do not make the same good choices I make.
Okay, my question could be interpreted that way. My intended question was "Other Americans don't make the same good choices; why do you think that is?"
Individuals should pay for their own bad choices. Im in Aus and a pack of smokes last year (yesterday) cost $28. Today $35. thats for 25 cigarettes. Taxes work. In america it's a little more tricky, and nailing down the cause of long term conditions is also tricky.
But if you're fat, smoke and don't do anything, and then you have a heart attack its kind of easy to link things together.
But if you're fat, smoke and don't do anything, and then you have a heart attack its kind of easy to link things together.
My understanding was that obese people and smokers ultimately cost less to insure because they tended to die relatively quickly and with less prolonged fuss. Should individuals pay for their own good choices?
http://www.nytimes.com/2008/02/05/health/05iht-obese.1.97488...
http://www.nytimes.com/2008/02/05/health/05iht-obese.1.97488...
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Interesting read. I guess is a balance of extra productivity from not dying vs getting rid of some smoker :P
Retirees tend not to have much productivity whether they are dead or not.
Retired folk are (or can be) still an economic benefit as long as they live. Consider the trivial case of a grandparent watching children so the parents can have time to recover. But obesity and smoking do not kill people the day they leave work for the last time, it kills people in their 40s with years ahead of them to be productive.
Diabetes is punishment enough for your hypothetical gluttony. I see no reason to arrange society in a way to further punish sick people.
They took a good idea (welness programs) and made a creepy dystopian thing out of it (biometric tracking for penalizing you on health insurance). That's what Weapons of Math Destruction is all about: tracking, data mining/collection, algorithms that discriminate people based on the data collected. This article is essentialy a advert for the book. I've read some of it in a library.
One of the big problem with Wellness programs is the same problem of measuring programmer productivity by tracking LOC -- it's a set of numbers that are only a proxy for the real thing. I look good on some numbers typically used and not so good on others, but I've only needed preventative maintenance for a while.
Of course, what the insurance companies really care about is their cost, not your actual health, which is why the folks with the discounted plans wound up using the insurance more at a past employer -- strong encouragement to exercise more caused more exercise-induced injuries, particularly among a set of mountain bikers that became competitive once the company started logging their mileage as part of the "Wellness" program ... and they started logging broken bones!
Of course, what the insurance companies really care about is their cost, not your actual health, which is why the folks with the discounted plans wound up using the insurance more at a past employer -- strong encouragement to exercise more caused more exercise-induced injuries, particularly among a set of mountain bikers that became competitive once the company started logging their mileage as part of the "Wellness" program ... and they started logging broken bones!
My employer gives me and my wife $50 total monthly deduction from our insurance payment for not smoking.
Of course if they find out you got sick from smoking, your coverage will be denied.
My worry is what if they try to use this as a way to avoid covering catastrophically expensive illness where the underlying cause might be ambiguous and subject to interpretation.
Of course if they find out you got sick from smoking, your coverage will be denied.
My worry is what if they try to use this as a way to avoid covering catastrophically expensive illness where the underlying cause might be ambiguous and subject to interpretation.
My company requires an annual health assessment be completed in order to avoid a higher insurance rate. There is no requirement that the data entered in the assessment be truthful. It seems like applying such a requirement would be difficult as all the data are self reported, therefore difficult to verify much of it. I have little objection to this approach.
On the other hand the "livewell" points scheme seems annoying. I wonder whether employers consider the added cost. Most employees will complete such extra work-imposed requirements while at work instead of actually working. Suppose this costs four hours per month, that could easily work out to 5k/yr in most tech jobs. That's probably an underestimate. How does that compare to the reduced cost of insurance coverage?
On the other hand the "livewell" points scheme seems annoying. I wonder whether employers consider the added cost. Most employees will complete such extra work-imposed requirements while at work instead of actually working. Suppose this costs four hours per month, that could easily work out to 5k/yr in most tech jobs. That's probably an underestimate. How does that compare to the reduced cost of insurance coverage?
I think healthy employees have benefits besides just insurance benefits. Being healthy has a lot of benefits in general (less sick days and in my experience better focus and mood) and people should be taking some short breaks during the day regardless. I think of these programs actually affect employee health then they are worth a cost
> I think of these programs actually affect employee health then they are worth a cost
That may be so. But there are multiple costs: lost work due to completing these mandates, potential indignation over privacy concerns resulting in excess turnover, and other second order effects. My experience with the financial management teams at multiple companies leads me to believe that none of these, beyond the first order cost reduction ("ooh, lower insurance costs!") are being considered.
It would not be that time consuming to complete an analysis of this. Depends strongly on your labour costs. But it should be considered. One could imagine this increasing the overhead of most large companies by a few percent, depending on how much the insurance reduction is.
That may be so. But there are multiple costs: lost work due to completing these mandates, potential indignation over privacy concerns resulting in excess turnover, and other second order effects. My experience with the financial management teams at multiple companies leads me to believe that none of these, beyond the first order cost reduction ("ooh, lower insurance costs!") are being considered.
It would not be that time consuming to complete an analysis of this. Depends strongly on your labour costs. But it should be considered. One could imagine this increasing the overhead of most large companies by a few percent, depending on how much the insurance reduction is.
Agreed with the livewell points scheme. It seems a classic case of starting out with something simple and then make it overly complicated.
I don't envy anyone who has to try to make people healthy, but looking at where we are heading it seems very necessary unless the government has to step in and impose calorie rations on overweight people.
I don't envy anyone who has to try to make people healthy, but looking at where we are heading it seems very necessary unless the government has to step in and impose calorie rations on overweight people.
I think the sane approach is to provide voluntary incentives, without excessive tracking or "punishments" for not hitting arbitrary targets. My company has quite a variety of informal health-related perks and programs (gym discounts, on-site yoga, fun runs, etc.) which many people seem to enjoy using or participating in. There's no coercion, either overt or implicit, which I think is the key to success with these kinds of lifestyle issues.
This is voluntary.
I think I'm getting at removing the "or else" part of the scenario.
Those interested in the legal basis for medical premium insurance discounts based on wellness programs should read
Incentives for Nondiscriminatory Wellness Programs in Group Health Plans. It has all the details on what is and isn't legally allowed.
https://www.federalregister.gov/documents/2013/06/03/2013-12...
https://www.federalregister.gov/documents/2013/06/03/2013-12...
As a European: WTF. This is a perfect example of what is wrong with the US healthcare system and employment-based health insurance.
The privacy headache of having the employer handle medical information alone would make this impossible (in Germany at least).
The privacy headache of having the employer handle medical information alone would make this impossible (in Germany at least).
Companies need to control healthcare costs which are quite high in the US. Things like screening etc. theoretically should help by catching diseases earlier starting prevention earlier.
The original sin here is that healthcare insurance is managed by a company instead of the government. That gives an employer too much power over their employees.
In Europe healthcare costs are just another tax, which rate is set by goverment and your employer is just responsible for substracting that from your salary and transfering to government's bank account, but has no say about how much you should pay.The plus side is that your employer simply does not give a damn about your lifestyle choices.
In Europe healthcare costs are just another tax, which rate is set by goverment and your employer is just responsible for substracting that from your salary and transfering to government's bank account, but has no say about how much you should pay.The plus side is that your employer simply does not give a damn about your lifestyle choices.
No the original sin is healthcare is not respected as a market.
In the US you can't get lower tier quality for a lower price. Literally every other industry has this.
In Europe HC costs are going up as well so your argument is invalid.
In the US you can't get lower tier quality for a lower price. Literally every other industry has this.
In Europe HC costs are going up as well so your argument is invalid.
You left out the third option: health insurance managed by the individual. Unfortunately has basically been eliminated as a choice by the ACA, as most of the affordable individual plans didn't qualify even if they were what the buyer wanted.
> The plus side is that your employer simply does not give a damn about your lifestyle choices.
Employers still want you to be healthy because they don't want you taking days off work sick. In-service death benefits from heart attacks or whatever could be hundreds of thousands of euros and they still pay them even if you have a national health service. It's probably cheaper to pay for a gym than sick days and in-death benefits.
Employers still want you to be healthy because they don't want you taking days off work sick. In-service death benefits from heart attacks or whatever could be hundreds of thousands of euros and they still pay them even if you have a national health service. It's probably cheaper to pay for a gym than sick days and in-death benefits.
You are partialy right, some employers will still care about your well being, but the point is that
1. Not all employers will care, and that fact alone gives you some choice.
2. Even employers that do care can only encourage you to live healty lifestyle but cannot punish you for not following their recomendations (financialy or otherwise)
1. Not all employers will care, and that fact alone gives you some choice.
2. Even employers that do care can only encourage you to live healty lifestyle but cannot punish you for not following their recomendations (financialy or otherwise)
Can we please not do this? There is no homogenized health insurance scheme across Europe. Switzerland has a different setup compared to Germany, which is different from France, which is different from the UK.
If you want to speak intelligently on the subject, identify a country and compare and contrast with the US.
If you want to speak intelligently on the subject, identify a country and compare and contrast with the US.
They are the same for the purpose of the argument being made above.
If the article were instead devoted to exploring the application of similar programs in a different context, perhaps it would have been named "Drive Safe or Else: How Car Insurance Companies Became Obsessed with Tracking Your Speeding Tickets".
There are clear benefits to charging insureds in proportion to risk, especially controllable risk. But of course these benefits need to be weighed against potential negative impacts. There's some discussion here about how to strike the right balance. It may be comforting to learn that actuaries, who design these risk classification programs, and regulators, who monitor and approve them, aren't just making this up as they go along. We're guided by principles, a basic summary of which [0] covers some of the topics discussed in this thread. Of course this only scratches the surface.
[0] http://actuarialstandardsboard.org/wp-content/uploads/2014/0...
There are clear benefits to charging insureds in proportion to risk, especially controllable risk. But of course these benefits need to be weighed against potential negative impacts. There's some discussion here about how to strike the right balance. It may be comforting to learn that actuaries, who design these risk classification programs, and regulators, who monitor and approve them, aren't just making this up as they go along. We're guided by principles, a basic summary of which [0] covers some of the topics discussed in this thread. Of course this only scratches the surface.
[0] http://actuarialstandardsboard.org/wp-content/uploads/2014/0...
Although I am in (mostly) good physical shape, I found it beyond creepy and refused to do it. But I worry about them increasing the discount in the future. It'll be harder to say no when it's $1000, or $2000. And let's be real: it's not a discount, it's a penalty for when you don't do what you're told.
And given how my insurance doesn't even cover a 30-minute ER visit without sending me a bill in the mail for $1700, it's hardly even worth having insurance at all. At least at my age.