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.

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.

A good doctor, especially when treating chronic patients, forms an essential part of the social structure necessary to treat a disease. In most cases handing out recipes for pills is (or should be) only a minor part. Many chronic diseases are exacerbated (or caused solely) by stress, unhealthy eating habits, lack of activity, depression, social isolation, unhealthy working environments, etc. Why treat the symptoms when you can treat the causes? Armed with this knowledge, an intelligent doctor treats using medicine and spurs habitual changes.

Another thing. You mention doctors are not intelligent and basically a human rolodex of knowledge. As an outsider, I've seen the complexity of our current understanding of the immune-system. Immunology alone has nothing to do with rote memorization. Compare it with diagnosing an extremely complex self-repairing, self-diagnosing, self-reproducing group of information systems. We have no complete manual. Performing proper tests is expensive and not 100% reliable. Although each information system within the group is similar, they are different in slight, unpredictable, undocumented ways. Oh, and each year, around 10 important books are published on new findings about these information systems. You only have time to read 5.

You might want to revisit this opinion.

But does it take wits? The medical researcher probably. The person who figures out the dosage, maybe. But the person who through rote learning knows of the top of their heads the proper dose? Meh.

The people on this forum probably average 130 IQ. Not everyone here could do a medical degree. But most are probably smarter than their doctors.

I disagree. I believe pretty much anyone has the ability to fill the role of a web developer if they take the time on their own to learn the skills. Not many people have the intelligence, focus and competence it takes to be in medicine.

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.

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.

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 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'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.

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)

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?

But you avoided his entire second question.

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.

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!

It's always phrased as the former, but employees that don't get the discount often see it as the later.

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.

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.

What's the difference?

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????

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.

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.

Many don't. Or they don't blame overeating. It's always "genetics" or "metabolism". Not just plain old overeating.

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.

It's self-destructive behavior just like overeating.