It's happening-Health insur surcharges for the overweight

Having just moved from England to come back to all of this rigamarole about Obamacare and the Affordable Care Act, I just keep asking myself why Americans just don't enact a National Health Service. I saw it in action over there and I thought it worked extremely well. But they won't - they'd rather bitch and whine about all the hidden costs in whatever plan is offered them.

But I will weigh in on the surcharge for smokers. A smoker can cause other people in his or her environment to be sick more often too. It's a proven fact that children of people who smoke have more ear infections and respiratory illnesses than the children of people who don't. And even if the smoker doesn't smoke in the home or around the children, they have proven that there is a third-hand smoke effect- that the lingering tobacco smell on a person's clothes can have an effect on those who are sensitive to and exposed to it. I cringe when I watch my nephew being held with his face pressed into his father's or grandmother's shoulder that I know reeks of the cigarette they just smoked outside, because I can smell it on them all the way across the room.
At least an alcoholic (unless he or she gets behind the wheel of a car) is only harming him or herself. Likewise an obese person who eats too much - unless they're forcing food onto other's plates and making them eat it.

So yeah - I just keep asking myself, do we want to take care of ALL sick people or don't we? This seems like a really complicated and half-assed way to try to look like we're doing the right thing as Americans when truly we're still just trying to keep our own asses covered and to hell with anyone else.

Without disagreeing with anything you've said, the flip side of the argument, in the UK at least where health care is funded by taxes, is that smokers already pay a surcharge.

A packet of 20 cigarettes cost about £7.98, (I had to look it up, that's double what I paid when I smoked,) and the tax on that is £6.17.

In short if everyone in the UK stopped smoking tomorrow the treasury would be in dire straits, which is one of the reasons they're so hot on tackling tobacco smugglers.

I am sorry but I cannot agree with you regarding alcoholics only hurt themselves is not correct. Often they are aggresive, beat up people, their wifes and children. Alcoholics smell too. It cost more to be an alcoholic than a smoker which often ruin the lives of the family.
Children have serious problems in families with alcoholic parent/s.

When I am even slightly under the influence I love all of mankind in fact I would likely even give Firefly a friendly hug.

Saab - what I meant was that smokers can have an injurious effect on the other people around them simply by being in the room with them after they've smoked. They don't even have to open their mouths or raise a hand to anyone. They are carrying toxins on their clothes and in their hair, etc. that can make other people sick.
Yes, I agree with you that the people around alcoholics are and can also be hurt by their behavior but if someone drinks a six pack and then falls asleep in the room next to someone who is sensitive, that person will not be physically affected as he or she would if someone smoked a pack of cigarettes and fell asleep in the room next to them.

Izzie - I don't know anything about taxes and surcharges on cigarettes here. I've never bought a pack. But I've stood in line behind people who have and they seem to cost 8/9/10 dollars a pack over here. I don't know how people can afford to smoke!

I know that passiv smoking is bad, but never heard that people get sick when being in room with a person who carry toxin in their clothes. That can only be a very very heavy smoker.
If it is the case then also women using perfume or men using after shave should pay higher insurance as they can cause allergic reaction for people. I have heard about and know someone who got astmatic reaction from other peoples´ perfume and aftershave.
Where shall we stop and where begin.

Well personally, and my initial point was, I think we should just have a nationalized health program and then we wouldn't even be having this discussion and we wouldn't have to worry about where to begin and where to end. If a person was sick, their illness would be taken care of - period.

But, if we're not going in that direction, I can understand why insurers would feel the need to charge higher premiums for people who engage in risky behaviors. And people who wear perfume and cologne, although yes, their scent can trigger allergies and asthma in others, are not dousing themselves in or inhaling chemicals that have been proven to be carcinogens and toxic.
Smokers are.

I'm sensitive to all environmental chemicals- so I don't enjoy sitting next to someone doused in perfume. But at least she's not making a conscious decision to risk her OWN health and asking me to pay for it down the line when she gets sick. That's what smokers are asking insurers to do.

I am all for a nationalized health program as I know in Sweden.
If we start with the smokers - as I have pointed out before - many things will follow.
In Spain bad teeth are concidered as your personel problem because you did not take good care of your teeth. The health insurance only pays for pulling teeth. Of course you can take an extra insurance for teeth. Then there is a two class health system.
Imagen if this starts with your health? Only basic health will be paid and anything which maybe could have been caused by your lifestyle you have to pay yourself or have extra health insurance.
I am absolutely against punishing anybody for their lifestyle. Especially if it leads to a two or even three class health system.
Just because you do not smoke does not mean you live a 100% healthy life.
Smokers often do die earlier - there you save the pensions plus they have paid much more taxes than others who do not smoke.

I agree with you on this, saab.

I've been somewhat mixed about it but mostly disagreeing with you as I read, getting the need to charge more re the behavior while arguing that it isn't always behavior that's the problem - but I come down to your point of view, which you have annotated well. I do believe in healthy living information being known, but in many ways that is a farce because of so much we have not understood, thus scientists learning anew yet again and later again. So many behaviors of all of us as causative of something. And opinionators roam the earth, some sincere, and some may end up being right, while on the stage next to charlatans. I'm an oldie research tech and though I stopped working in that field, tend to follow medical news. Caramba!

I also get the difference, Adrian, between perfumed folk and smokers re public health. I was a heavy smoker, quit in 82, so I get the whys of that behavior and the ickyness and toxicity. But in balance I am seeing saab's take as smart.

This is actually an occasion of someone on a2k changing her mind because of another person's annotations. It's possible, however rare.

A compliment from you is like getting a goldmedal. Thank you very much.

Are you serious or are you plain uninformed?

In the US, the only individuals who see an MD 18 times a year are those on Medicaid ( free care ), the very elderly ( who see an MD in either their nursing homes, or assisted living groups) and the very sick ( diabetics, kidney failure, cancer patients, transplant patients ). In other words, to the average American, 18 visits/year to an MD is very excessive.

Why do Germans visit their doctors so often? Are Germans in extreme
poor health?

With so many visits to their MDs, when do Germans have time to work or anything else?

What saab quoted, is the average.
From those figures, 25% don't visit a doctor at all.
Besides that: we do have a totally different system here: of course you can go to a doctor's practise during their office hours (from 8 to 8 mostly). And outside working hours of the practises, you go (or call) to th local "out of hour practise on duty", 24/24 mostly.
Opposite to the USA, self-medication isn't done here so much. So this adds to doctors' visits, too.
If you need a prescription for a medicament constantly (like I do for a skin cream) - so you have to go to the doctor's every month to get it.
When you're ill and can't work, th doctor has to give you that "certificate".
Than, you go there for all the free examinations and check-ups ... ... ...

You probably never have been walking by some alcoholics hanging around in the streets only met the ones who can keep their alcohol level at a point so they seem sober.

The system in Sweden is the same as in Germany.
Older and serious ill people visit more than the healthy.
You pick up your prescription at the doctor´s office, which does not always mean you see the doctor but it is counted as a visit.
Reading the articles in connection with the infornation about visiting doctors in EU it is clear that Germany has a great tedency to hypochondriacts.

At least here you don't routinely need any "certificate" from a doctor to miss work - unless you either have a very controlling employer or a reputation for missing work on the first or last day of the week.

Long term prescriptions are normally refillable for a specific number of times. At the end of that number of refills, the pharmacy generally makes a call to the doctor's office and someone authorizes. This isn't always the case, but that's the normal situation.

You are a psychologist or psychiatrist, able to do telediagnosis?

From the first day onwards, because the health insurance pays your salary, you get that "certification".

Doctors have certain budgets for certain patients/medications/prescriptions (depending on where they practise, speciality etc). So they can't prescribe all medication over a longer period.

It isn't. But "we" are trying hard to get down to it (mainly, because of the savings)

That's clear, and if they want to pay my salary, they can certify till their hearts are content. Many companies (not all) have an allowable number of sick days, and they are the most likely to require certification - which we generally call "a note from the doctor".

The comments on budgets for patients/medications, etc are interesting. I had no idea just how far apart we were.