Well piezoe

DHOHHI, I wonder if the obesity problem isn't somewhat related, among other things, to education, achievement, and consequent self-esteem. My reason for thinking this is that the problem is worse in the States with the lowest educational achievement, highest unemployment, and highest poverty rates. These things seem to be linked.

Let's suppose it is true. Then that would suggest that if we can improve public education, besides many other benefits, we might get some health gains out of that as well.

One other observation, it would seem that heavy smokers and drinkers of alcoholic beverages pay much more in State taxes than non-smokers/non-drinkers, ceteris paribus. Perhaps their greater contributions to the public coffers largely compensates the public for their greater drain on health services. Smokers, generally pay higher individual insurance premiums, but not on group policies where they may be responsible for all groups members rates increasing some.
 
Quote from piezoe:

DHOHHI, I wonder if the obesity problem isn't somewhat related, among other things, to education, achievement, and consequent self-esteem. My reason for thinking this is that the problem is worse in the States with the lowest educational achievement, highest unemployment, and highest poverty rates. These things seem to be linked.

Let's suppose it is true. Then that would suggest that if we can improve public education, besides many other benefits, we might get some health gains out of that as well.

One other observation, it would seem that heavy smokers and drinkers of alcoholic beverages pay much more in State taxes than non-smokers/non-drinkers, ceteris paribus. Perhaps their greater contributions to the public coffers largely compensates the public for their greater drain on health services. Smokers, generally pay higher individual insurance premiums, but not on group policies where they may be responsible for all groups members rates increasing some.
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You're correct that there is very likely a positive correlation between the variables you cite and obesity. That said, I'm in my 13th year of volunteering in schools (helping kids with math) and the bulk of my experience is in high poverty schools where 90+% of kids get free/reduced lunch. But at the same time there are programs offered to the community and directed towards parents that cover everything from financial literacy to healthy eating to the benefits of exercise. Sadly, many events are poorly attended. Thus the cycle continues. But most of these parents/families are on Medicaid. There are plenty of other people in the US, who are not living in poverty, who fall into the overweight/obese category as well. Kids sit around with their video games, watch TV, tweet, post on Facebook and just surf the web. When I was a kid we were outdoors until dinner time playing baseball, football, basketball. The obesity problem is not just adults as you know but kids as well.

So when I rant about Obamacare I'm looking beyond the higher poverty people who likely depend on Medicaid. I'm asking why my (and my wife's) premiums will go up 180%. That number suggests a lot of unhealthy people with pre-existing conditions and many are middle class 'slobs' who just don't seem to care how they look. Not condemning everyone here but my original point was there should be either an incentive to be healthy or a penalty for those who overtly choose to be unhealthy.
 
the original insurance started with about 9 or ten English ship owners. They noticed that their business was highly profitable.
But if even one of their ships sank, it would darn near put them in bankruptcy.

So they pooled, but you had to have good safe ships and captains to join the pool.

Same today, life's pretty good, but one child with leukemia can darn near wipe you out.

I bet I could find 50 other low risk healthy eating healthy living families and pool.
 
DHOHHI, Thank you for your volunteer work!

I'm sure you have already considered the various aspect of health insurance, but it won't hurt to bring them up here in case their are younger ET people who are just now confronted with having to buy health insurance, perhaps for the first time.

Your insurance company, of course, isn't charging you less because you eat healthy, exercise regularly, and don't drink heavily -- they may give you a little lower premium if you don't smoke, however. Instead, they are giving you a lower premium because you have no history of chronic disease, are in an age category with low incidence of medical problems, and you are willing to take on more risk by choosing a quite high deductible. So it isn't your lifestyle that is giving you that lower premium, it is your age, your height/weight proportionality, and medical history. They would have no qualms about rating you up once you've reached a category where medical problems are more probable. You can argue that your lack of chronic disease is due to your healthy life style, and it may be, but you have no way of knowing that it isn't good genes and good luck, and neither does the insurance company. If fact, they will give a heavy drinker and heavy smoker almost the same rate as you, if they fall in your age category, have a similar medical history as you, and are not obese. The company you obtained your policy from will have no qualms about raising your rate as you age. This is how insurance underwriting works. There are no insurance company spys tailing you past the the bean sprouts to see if you stop at the Fritos.

I don't know how the ACA approved policies work, but I hear they have levels of coverage available as well, and if you want a lower premium you can choose to take on somewhat greater risk, as you are now. The main reason you might pay more for a policy is because you are assuming less risk. That's how insurance works.

No matter how healthy you are now, you never know when you will be stricken with some horrible disease or genetic disorder, be in a horrible accident, have a stroke, etc. It is completely impractical to underwrite insurance on other than the law of averages.

I sympathize with your desire to take on more risk yourself, and with your frustration if the ACA policy choices do not give you the option of taking on as much risk as you want. Because we still have the McCarran Ferguson act in force, your State regulator will ultimately determine what choices you have, but my guess is there will be huge pressure put on State regulators to not permit non-compliant policies to be sold. On the other hand, as we get further into this strange hybrid known as Obamney care, there is a high likelihood that policy choices will be expanded, and that some of those choices may include taking on much more risk. So stay tuned, and good luck. Regardless, please recognize that if you end up paying more for your coverage you will at least, in theory, be taking on less risk.

P.S. I am not personally enthusiastic at all about Obamney care and the way it is shaking out. I see huge problems ahead, particularly if McCarran-Ferguson isn't repealed.
 
Now here is a little something I hesitate to bring up, because I really don't know what I am talking about, yet this bothers me. There is another reason you might pay more with ACA policies. The ACA policies are intended to bring the features of group policies to everyone. What that means is a little hard to tell, so I'll guess that in each State everyone with the same carrier will be in the same group, I assume, to create the largest groups possible. But with McCarran-Ferguson in place, companies that sell in only a few states obviously can't form as big a risk pool as a company that, say, is licensed in all 50 States (it's immediately obvious that the only way this can work at all is for standard policy features to be dictated by HHS, and the State regulators to agree to go along.)

"Theoretically" the participant companies will be selling individuals and companies the same policies now, the only difference being that companies will pay the premium for their employees. (We have absolutely lost our minds to keep the company mandate in place!; there is no need, other than to add still more complexity, for it now that we have the individual mandate.) In theory of course, if you can bring a lot of young healthy customers into the group, you can charge them a little more for their coverage then you might charge if they were in their own group, and charge the highest risk categories a little less. And finally, theoretically, selling policies to millions of new, very healthy customers can be highly profitable, and theoretically those billions in additional profits can be used to reduce everyone's premiums, while still providing a reasonable ROI for the insurance companies. But, theoretically, those windfall profits can also buy sets of alligator luggage for Board members prior to their annual junket to Waikiki. So where are the controls to see that much of the windfall profits get passed on as lower premiums?

Presumably, because neither the youngsters nor those covered by expanded medicaid -- nevermind the insanity of the Court allowing 25 States to opt out! -- are not supposed to show up at the emergency room any more, E.R. savings will, as if by magic, end up being passed on to everyone in the State groups, young and old alike. Well you don't have to be a rocket scientist to see that this scenario depends on, it would seem, hospital administrators acting ethically, and not moving the savings --they'll need a lot fewer E.R. personnel-- into executive salaries, etc. In other words, in that 1000 page ACA, where are the greed controls? And what if hospital administrators have been lying, and the reason E.R. costs are so high is to cover outrageous administrative salaries in the first place? Are these guys now going to volunteer for a pay cut. I doubt it. So there are huge unknowns in all of this. Nancy Pelosi was not kidding when she said we'll have to wait to find out what's in it!

Trying to make the ACA work while leaving McCarran-Ferguson in place will be like like trying to drink a beer by pouring it in your ear. I find extremely ironic Obama's assertion that the reason we went with the Heritage Foundation plan (same plan Massachusetts went with) was because it would cause less upheaval -- I assume he was referring to insurance company upheaval, or was he referring to upheaval in campaign contributions? :D If he was concerned about upheaval, there would have been far less had Congress started by repealing McCarran Ferguson. But what's really ironic is that the simplest course of all would have been just to extend medicare to everyone, let us pay our premiums as we do now through payroll deduction, and let the insurance companies sell whatever supplemental coverage than can, just as they do now to the medicare covered. And since Obamney care was passed without a single Republican vote -- Ok, so Baucus is an honorary Republican-- they might have been able to actually go that route! Oh well.

I agree with you Nancy, we'll just have to wait and see what's in this thing. <a href="http://www.freesmileys.org/smileys.php" title="Smiley"><img src="http://www.freesmileys.org/smileys/smiley-confused013.gif" alt="Smiley" border="0" /></a>
 
Quote from piezoe:

DHOHHI, Thank you for your volunteer work!

I'm sure you have already considered the various aspect of health insurance, but it won't hurt to bring them up here in case their are younger ET people who are just now confronted with having to buy health insurance, perhaps for the first time.

P.S. I am not personally enthusiastic at all about Obamney care and the way it is shaking out. I see huge problems ahead, particularly if McCarran-Ferguson isn't repealed.
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But here are just a few more points that seem to have been swept under the rug by the pro-Obamacare people.

(1) ACA was intended to extend health insurance to the millions of uninsured people. I am already insured. Let us keep what we have if we are truly happy with our coverage. those who are not happy with their individual policies are more than welcome to see what's on the exchanges.
(2) Mandated coverages. At age 59 I (and my wife) do not want or need maternity care so why should be be forced to have it? It clearly is an additional part of our premium and is wasted $$$ for us. Same with the fact we are forced to have pediatric dental care ... and pediatric vision care. Again, we don't want/need this. And even more funny is that the core requirements do not include vision or dental for ourselves but we have to cover the pediatric subset.
(3) Our current policy is great; $364/month with $10K deductible. It is NOT "lousy" as Odumbo has stated relative to catastrophic policies. We both get a free annual physical, mammogram for her, prostate exam for me and both of us colonoscopies as part of preventive coverage. But the new policy we will be forced to buy is, in fact, LOUSY and at $1000/month a 180% increase. Add in that the deductible goes up by 27% (to $12,700) and we have a crappy policy.
(4) marriage penalty. If our income exceeds $62K (i.e. $31k/each) we get no subsidy. Yet, 2 unmarried people can both get up to $46K each, or $92K before subsidies phase out. For 2015 we likely will get an 'official' divorce so we can perhaps get some kind of subsidy assuming we can minimize trading/investing income.
(5) why is someone in DC deciding what's best for all of us? And as a compromise they should roll out different coverages for different age groups. A 20 year old doesn't need a colonoscopy just as a 60 year old doesn't need maternity coverage.
 
Quote from kid.fx.cross:

as a matter of fact, what is it in the state exchanges? 400% or less over poverty you qualify for Medicaid. How is that bad? Isn't that what we want is to make sure the poor can get healthcare without showing up in ER and sticking the hospital and in turn all of us whether we are insured or naked with the bill? (that would actually be better because it eliminates one level of bureaucracy), although as piezoe points out, that is the most expensive health care, so we are kind of chasing our tails.

Other than politics, I can see why red states didn't go with a state exchange. After all, after a coupe of years of free hand outs from the federal government, where is the money going to come from?

It will be interesting to see what happens with Kentucky and Washington State.

So correct me where I am wrong, if it all goes well, we end up with a single payer system for anyone at 400% or less over poverty, presumably paid for in one way or the other by those over 400%.

Socialism at it's finest. Means tested benefits for the poor, and leave those of us that are not poor alone. (except of course on April 15 when we have to pay for it all.)

well piezoe and Tsing and JamesL, what do you think?

otherwise I already know Obama is stupid (or diabolically intelligent) so no need to continue your shallow childish posts. I don't put people on ignore, because I enjoy opposing view points, but if a constant barrage of propaganda spewing forth the party line is what I needed I could just turn on tv. So, I would consider it a patriotic honor if you would please, just put me on "ignore."
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Actually, now that I think about this I believe you may have confused the the cut off for the phased-out premium subsidies with medicaid qualification. I believe these are two different things. What it takes to qualify for medicaid is different and varies from State to State. For example a single person without dependents probably doesn't qualify for medicaid nor matter how small their income, including zero! What medicaid expansion was supposed to do, I believe, is cover some of those who couldn't previously qualify even though they had income well below the poverty level. Of course the Court threw a monkey wrench into the ACA by allowing States to opt out of medicaid expansion.
 
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