The stupid explodes: obesity now a disability

[cullennz]

So, I guess I'd have to ask why not... if the principle is "your choices contributed to your condition therefore you should subsidize the treatment, not me" then these should all be valid criteria for prioritizing patients' share of common resources.

I live in a country where medical just comes out of tax. Including in case of any accidents.

Smokers and alchys are pretty much the only ones subsidising themselves in tax hikes

 

[blutoski]

I live in a country where medical just comes out of tax. Including in case of any accidents.

Smokers and alchys are pretty much the only ones subsidising themselves in tax hikes

I guess I don't understand your point. My impression is that the majority of the tax input is from income tax.

"Sin taxes" are not designed to be sufficient to fund future treatment; they are designed to deter the behavior and reduce the requirement for future treatments.

Healthy people subsidize unhealthy people in this type of system (private or public).

 

[The Atheist]

And if you catch aids?

HPV?

Food is just as obsessive as sex.

You can have sex with a person with HIV and not get it.

If you shovel food unnecessarily into your throat, you will get obese.

Well, wait... what if the kid had a genetic condition that was detectable by the parent prior to birth? (eg: Down's Syndrome complications, Tay Sach's, &c) The expense on the system was a choice, so should the patient in question also be deprioritized? What are the inputs? Personal revulsion? Popular vote?

I'd be perfectly happy for parents to pay the price rather than the taxpayer. (me)

If they choose to bring a child into the world who will require enormous extra expense to raise, then it should be their responsibility to pay for it. My boy (7) has a Down Syndrome kid in his class. The child requires an entire additional staff member on the school's payroll, whose only duty is to care for the kid.

This is all subject, of course, to screening for DS being almost 100% effective in identifying it.

This is the sort of exercise that gets discussed in medical ethics texts, and ultimately the conclusion is that employing moral failings of the patient as an input to allocating their care is unethical. It's using a 'medical' system as a 'moral reward' tool.

I'd be disappointed in anyone in the medical profession who felt that way, but doctors have never been the most ethically-advanced group.

However, ethical doesn't mean illegal, and this is how we get real death panels.

Emotive language works well in these situations, eh? Death panels.

 

[cullennz]

I guess I don't understand your point. My impression is that the majority of the tax input is from income tax.

"Sin taxes" are not designed to be sufficient to fund future treatment; they are designed to deter the behavior and reduce the requirement for future treatments.

Healthy people subsidize unhealthy people in this type of system (private or public).

Tobacco here is at a price that more than covers medical costs

 

[blutoski]

You can have sex with a person with HIV and not get it.

If you shovel food unnecessarily into your throat, you will get obese.

Some people don't... that's the genetic lottery.

I'd be perfectly happy for parents to pay the price rather than the taxpayer. (me)

If they choose to bring a child into the world who will require enormous extra expense to raise, then it should be their responsibility to pay for it. My boy (7) has a Down Syndrome kid in his class. The child requires an entire additional staff member on the school's payroll, whose only duty is to care for the kid.

This is all subject, of course, to screening for DS being almost 100% effective in identifying it.

It is, and in most western countries with public healthcare, it's a free service, as is the TA procedure.

I'd be disappointed in anyone in the medical profession who felt that way, but doctors have never been the most ethically-advanced group.

Which is why medical ethics are much discussed, but I'm confused by your comment. It sounds like you're saying you'd be disappointed in anyone in the medical profession who agreed with you?

Emotive language works well in these situations, eh? Death panels.

It's a direct reference to US politicians' objections to single-payer "publicly funded" healthcare, such as Obamacare. They argue that such a system would be unethical because it would have managers prioritizing some people's access to the resources over others based on moral factors. Deprioritizing obese people "because they did it to themselves" (as opposed to "because they have less chance of surviving the operation") would be a good example. Link: [Death Panel]

 

[cullennz]

Some people don't... that's the genetic lottery.





It is, and in most western countries with public healthcare, it's a free service, as is the TA procedure.





Which is why medical ethics are much discussed, but I'm confused by your comment. It sounds like you're saying you'd be disappointed in anyone in the medical profession who agreed with you?





It's a direct reference to US politicians' objections to single-payer "publicly funded" healthcare, such as Obamacare. They argue that such a system would be unethical because it would have managers prioritizing some people's access to the resources over others based on moral factors. Deprioritizing obese people "because they did it to themselves" (as opposed to "because they have less chance of surviving the operation") would be a good example. Link: [Death Panel]

I should point out what I think should happen with priority of patients unfortunately doesn't match how our public medical system works.

Lardys, alchys, druggies are just in the queue in whatever order they show up.

 

[blutoski]

Tobacco here is at a price that more than covers medical costs

I'd have to see the numbers, because that would make NZ the only country in the world to accomplish this. Recall that we're not talking about total revenue from these 'sin taxes'; just the revenue from the subdemographic that abuse the product enough to cause health problems. The 99.9% of us who have a few beers on Friday night contribute liquor tax, but are not paying forward for a liver transplant, and contribute the majority of the funds that will be allocated to the relatively small number of treatments.

Generally, in pooled resource systems (public healthcare, private insurance) the healthy subsidize the unhealthy, the exercisers subsidize the sessile, the educated subsidize the uneducated, the higher incomes subsidize the lower incomes.

When an individual is asked "which of these is unfair?" they sort out which categories they're in and if they find themselves on the receiving end here and there, promptly exonerate themselves, and point fingers at whatever categories remain.

 

[cullennz]

I'd have to see the numbers, because that would make NZ the only country in the world to accomplish this. Recall that we're not talking about total revenue from these 'sin taxes'; just the revenue from the subdemographic that abuse the product enough to cause health problems. The 99.9% of us who have a few beers on Friday night contribute liquor tax, but are not paying forward for a liver transplant, and contribute the majority of the funds that will be allocated to the relatively small number of treatments.

Generally, in pooled resource systems (public healthcare, private insurance) the healthy subsidize the unhealthy, the exercisers subsidize the sessile, the educated subsidize the uneducated, the higher incomes subsidize the lower incomes.

When an individual is asked "which of these is unfair?" they sort out which categories they're in and if they find themselves on the receiving end here and there, promptly exonerate themselves, and point fingers at whatever categories remain.

http://m.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10809145

 

[Minoosh]

It must have been a fairly big thing at one time, or we wouldn't have evolved to live as long as we do. Society benefited from retaining the knowledge and wisdom of older people.

I think that's due less to evolution and more to innovating our way past a ton of things that used to kill us a whole lot sooner (on average).

Though humans do have some traits that make no adaptive sense to me. Young 'uns who are completely helpless for 2 years? Surely grandparents came in handy, but is changing society "evolution"? I literally do not understand how humans got the edge to become the planet's dominant species.

But it's really easy for me to see how people get fat. We would be more programmed to gorge than to eat 3 moderate meals daily.

 

[Skeptical Greg]

......Some people don't... that's the genetic lottery.....

Whether some people ' don't ' is beside the point..

The people who 'do', are a burden on society and the healthcare system..

 

[cullennz]

I think that's due less to evolution and more to innovating our way past a ton of things that used to kill us a whole lot sooner (on average).

Though humans do have some traits that make no adaptive sense to me. Young 'uns who are completely helpless for 2 years? Surely grandparents came in handy, but is changing society "evolution"? I literally do not understand how humans got the edge to become the planet's dominant species.

But it's really easy for me to see how people get fat. We would be more programmed to gorge than to eat 3 moderate meals daily.

Maybe 2000 years ago

 

[Minoosh]

Finally, someone has accepted that incessantly and unnecessarily shoving food into your face is as much your fault as smoking.

This statement is strongly informed by a dualistic world view. Willpower, mind over matter, etc. "Mind" and "brain" being two different things. But I'm not sure that's valid. An overfed pet dog is not at fault if it gets fat. It is just doing what dogs have always done: Eat their fill at every opportunity. If humans are qualitatively different than other animals, when exactly did personal responsibility evolve?

According to a recent New Yorker article, "Diet and exercise alone rarely help people lose weight and keep it off." Is that their "fault"? Maybe. I find it more helpful to think in terms of responsibility: Anyone can be predisposed to putting on weight or getting addicted to substances. There are huge industries devoted to making people overeat and use addictive substances. I don't think shaming people helps. You want to empower them. I do, anyway. Can't speak for you.

This New Yorker article looks at it from a practical angle:
Bariatric Surgery: The Solution to Obesity?

 

[Skeptical Greg]

Is that their "fault"?

Who else's fault would it be?

I certainly don't approve of shaming; it's a form of bullying.

On the other hand, I don't approve of enabling either..

 

[cullennz]

This statement is strongly informed by a dualistic world view. Willpower, mind over matter, etc. "Mind" and "brain" being two different things. But I'm not sure that's valid. An overfed pet dog is not at fault if it gets fat. It is just doing what dogs have always done: Eat their fill at every opportunity. If humans are qualitatively different than other animals, when exactly did personal responsibility evolve?

According to a recent New Yorker article, "Diet and exercise alone rarely help people lose weight and keep it off." Is that their "fault"? Maybe. I find it more helpful to think in terms of responsibility: Anyone can be predisposed to putting on weight or getting addicted to substances. There are huge industries devoted to making people overeat and use addictive substances. I don't think shaming people helps. You want to empower them. I do, anyway. Can't speak for you.

This New Yorker article looks at it from a practical angle:
Bariatric Surgery: The Solution to Obesity?

Your comparing humans with choice to a reliant thick animal who has a useless owner who over feeds it?

Next you will be saying parents making their little kids fat isn't the parents fault

 

[cullennz]

Let me give an example.

I'm not saying my sister is Mary Poppins but my nephews get fizzy drink and McDonald's only as a treat at someone's birthday party.

Fish and chips is the odd one they get every couple of weeks.

 

[Roboramma]

I'd have to see the numbers, because that would make NZ the only country in the world to accomplish this. Recall that we're not talking about total revenue from these 'sin taxes'; just the revenue from the subdemographic that abuse the product enough to cause health problems. The 99.9% of us who have a few beers on Friday night contribute liquor tax, but are not paying forward for a liver transplant, and contribute the majority of the funds that will be allocated to the relatively small number of treatments.

Generally, in pooled resource systems (public healthcare, private insurance) the healthy subsidize the unhealthy, the exercisers subsidize the sessile, the educated subsidize the uneducated, the higher incomes subsidize the lower incomes.

The poster above was talking about tobacco and not alcohol. I'd suggest that there's a difference in that there is a healthy level of alcohol intake (a glass of wine with dinner may be better than none), but the same isn't true of tobacco.

Further you seem to be making a distinction between those who increase their risk of requiring medical treatment by engaging in a particular habit (smoking here), and those who end up requiring said treatment. I doubt anyone would suggest that the treatment of the individuals who end up sick is payed for by their extra taxes, but whether it's paid for by all the taxes paid for by the group who put themselves at greater risk is a different, and I'd suggest more relevant, question.

The point seems to be that those who don't engage in risky behaviour shouldn't, or at least don't want to, pay for the consequences of that risk. Whereas it seems entirely reasonable that all those who engage in said behaviour share the cost of it's outcome.

 

[cullennz]

The poster above was talking about tobacco and not alcohol. I'd suggest that there's a difference in that there is a healthy level of alcohol intake (a glass of wine with dinner may be better than none), but the same isn't true of tobacco.

Further you seem to be making a distinction between those who increase their risk of requiring medical treatment by engaging in a particular habit (smoking here), and those who end up requiring said treatment. I doubt anyone would suggest that the treatment of the individuals who end up sick is payed for by their extra taxes, but whether it's paid for by all the taxes paid for by the group who put themselves at greater risk is a different, and I'd suggest more relevant, question.

The point seems to be that those who don't engage in risky behaviour shouldn't, or at least don't want to, pay for the consequences of that risk. Whereas it seems entirely reasonable that all those who engage in said behaviour share the cost of it's outcome.

No politician alive would double the price of a mid range bottle of wine.

But you can tax the hell out of cigs because only the lower end and the dim smoke.

And they don't always vote

 

[cullennz]

The poster above was talking about tobacco and not alcohol. I'd suggest that there's a difference in that there is a healthy level of alcohol intake (a glass of wine with dinner may be better than none), but the same isn't true of tobacco.

Further you seem to be making a distinction between those who increase their risk of requiring medical treatment by engaging in a particular habit (smoking here), and those who end up requiring said treatment. I doubt anyone would suggest that the treatment of the individuals who end up sick is payed for by their extra taxes, but whether it's paid for by all the taxes paid for by the group who put themselves at greater risk is a different, and I'd suggest more relevant, question.

The point seems to be that those who don't engage in risky behaviour shouldn't, or at least don't want to, pay for the consequences of that risk. Whereas it seems entirely reasonable that all those who engage in said behaviour share the cost of it's outcome.

And "poster above" was humorous poster I am quoting

 

[Minoosh]

Who else's fault would it be?

If a girl becomes anorexic, is it her fault?

I certainly don't approve of shaming; it's a form of bullying.

On the other hand, I don't approve of enabling either..

That's a hard needle to thread and I think for public health purposes personal blame is unhelpful. What happens a lot is that some problems are "overdetermined." U.S. food manufacturers spend a lot of money figuring out how to get people to overeat. Now imagine that some people are genetically more predisposed to overeat than others, or have slower metabolisms, or are shorter. They are overdetermined to get fat. Either fact alone is a risk factor; taken together they become a near certainty. Certain Indian nations are highly prone to Type 2 diabetes. A genetic predisposition + risk factor = lots of suffering. If only they had some self-control ... but maybe it had something to do with living off Army rations of flour, salt and lard. You get a delicious metabolical disaster. Add alcohol, make it worse.

Other industries will push skeletal human clothes hangers as the epitome of attractive and teenage girls will starve themselves, sometimes to death. Why does this happen to some girls and not others? Is agency involved at all? All they have to do to save themselves is eat. But it's horrific to them. They will imagine themselves grossly obese when everyone else can see they're dangerously underweight. It doesn't happen to all young girls; but there might be patterns as far as who's at risk.

Freddie Mercury's death was his own fault. Or was it? There happened to be a brief period in history when the consequences of promiscuity were somewhat manageable (post-penicillin, post-Pill, pre-AIDS) and quite a few people fatally misjudged the finer points of viral epidemiology.

Thousands of people are "ejected" from cars every year; it's their own fault they weren't wearing a seat belt.

Many emergency room visits would be unnecessary if people refrained from patently stupid behavior.

Many problems in public health have a behavioral component, but often levels of risk involve other factors that are out of an individual's personal control. IMO the "blame game" is ... simplistic? Unhelpful? Counterproductive?

Let me give an example.

I'm not saying my sister is Mary Poppins but my nephews get fizzy drink and McDonald's only as a treat at someone's birthday party.

Fish and chips is the odd one they get every couple of weeks.

I totally get that public health problems are often the result of ill-advised choices. But there are other factors too. If a family is relying on McDonalds for supper and that becomes a pattern, then behavior gets more entrenched. A shocking number of people don't know that "fat-free" foods can make you FAT. They don't know that putting ranch dressing all over their salads makes calorie content soar. I tend to think Americans are more ignorant than people in other countries, though I don't know that for a fact. Partly it is not wanting to walk 10 steps if it can be avoided, lift anything heavy if it can be avoided, get up to change the channel if it can be avoided (we get our exercise looking for the remote!). It might just be easier in the U.S. to avoid walking. Put everything at the scale of automobiles, create drive-in windows and attached garages, and we barely have to move at all.

This Washington Post account may be superficial and oversimplified, but it does illustrate what I'm talking about. The way societies are designed, or evolve, carries impacts down to the individual level, so that individual responsibility is partially eclipsed by larger changes in the environment.

 

[cullennz]

The stupid thing is if you make your own. Burgers, tacos and pizza etc can actually be tastier and better for you