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Old 12-08-05, 06:38 PM   #1
markhr
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should medical care be denied people who live in an unhealthy manner?

That is, if the disease/injury/symptom is brought about by poor diet and/or lifestyle choice should medical care be denied and can future care also be denied if their lifestyle merely makes those problem worse?
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Old 12-08-05, 06:56 PM   #2
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Interesting question, but perhaps it belongs in P&R. And of course, I presume you mean public funding for health care for these people, not overall access.

One part of me says yes, but how do we qualify people? How do we differentiate between people who, for example, have are naturally prone to high cholesterol and those who eat lot's of crappy food?

I don't think I'm going to get into this one too deep since I don't really understand the healthcare system. I haven't even been to a doctor's office in over 5 years, and that was just for a sports physical.
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Old 12-08-05, 07:34 PM   #3
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I'm sure there could be a denial of coverage for a broken arm while mtn biking
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Old 12-08-05, 07:47 PM   #4
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I love to watch the old geezers on oxygen smoking, especially the ones who have to put the cigarette up to the stoma in their neck.

You might be able to do it by risk factors assigned by insurance r/t weight, health habits ect. I don't think the system would be too fair because there are so many factors that may or may not be easily identified. For example race, income, genetics and so forth.

I don't think you can do it. If it makes you feel any better though, you should live longer and be healthier and can work more to pay taxes to care for all the unhealthy ones. Or, you could eat, drink and be merry and die like the old geezers smoking on the park bench with their oxygen and laugh at all the joggers and bikers going by and say to yourself; " Yeah, keep it up sucker, gotta go to the doctor next week."
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Old 12-08-05, 07:53 PM   #5
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So much for socialized health care eh?
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Old 12-08-05, 08:25 PM   #6
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There are many commonalities between chronic illnesses brought on by poor lifestyle choices (smoking, drinking, drugging, inactivity, poor diet), and those brought on by uncontrollable circumstances (environment, genetics, predisposition, malnutrition, poverty). Who would be empowered to choose those worthy of treatment? Physicians? The government? Lawyers? Failure to give due consideration to all would destroy the healthcare system. It would function only for those able to pay the price of good health.
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Old 12-08-05, 08:35 PM   #7
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The ultimate health insurance policy: Coverage only for people who are 100% healthy...it expires if they become ill.

I once had a job that included "free" medical care from an HMO. Each time one of my co-workers got sick, they were told that whatever they had was "excluded" from coverage by the HMO. So, we were always passing the hat to pay for someone's medical bills.

I suspect that is the ultimate goal of most health insurance policies: "We are currently denying the claims of those people who have a condition that seems unhealthy". The VA has a similar policy. A vet gets cancer. Has maybe three months to live. He will be put on a six month waiting list to see a specialist or he is told he must wait six months to be eligible for VA prescription benefits. His care won't cost the VA a penny...the VA will provide a "free" tape recording of a bugle for his funeral.
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Old 12-08-05, 11:38 PM   #8
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I would think smoking would qualify somebody to not receive it, but that person may think that my activities (mountain and road biking, skiing, drag racing, all with their inherit risks) would qualify me not to receive it. But then the guy who commutes via the internet, runs on a tread mill all day, and only eats rice and soy would scoff at both of us because of our activities make him look superior with his full coverage at minumumal cost.
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Old 12-09-05, 05:46 AM   #9
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Imagine the precedant that could be and what it might turn in to.

We can't save your wife's life, I'm sorry. Our records show that you were 4 miles over the speed limit at the time.

No, we can't do your heart bypass surgery, it shows here that you ate an order of french fries in 1987.

Broken leg? Well you should have thought of that before you started sliding down a snow-covered mountain on nothing more than a few wooden sticks!!!!


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should medical care be denied people who live in an unhealthy manner?
HELL NO!
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Old 12-09-05, 06:52 AM   #10
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Yet life insurance coverage is routinely suspended for people who sky dive.
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Old 12-09-05, 06:55 AM   #11
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"Sir, your application indicates you commute to work on your bike? Our statistics show that you're more likely to be involved in an accident then the average commuter. Sorry, insurance denied."
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Old 12-09-05, 07:49 AM   #12
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http://news.bbc.co.uk/1/hi/health/4508100.stm

Poor lifestyle 'a factor in care'

Patients could be denied treatment if their lifestyle makes it ineffective, the NHS advisory body says.
But the National Institute for Health and Clinical Excellence (NICE) said treatment should not be denied because their condition was self-induced.

NICE said it could be difficult to assess whether illnesses were down to poor lifestyle, such as smoking.

Its report said age should only be a factor if it directly affected the need for or effectiveness of a treatment.

The report - Social Value Judgements - also said social factors such as income and class should not be taken into account.

NICE GUIDANCE
Nice and its advisory bodies should avoid denying care to patients with conditions that are, or may be, self-inflicted
If, however, self-inflicted cause/causes of the condition influence the clinical or cost effectiveness of the use of an intervention, it may be appropriate to take this into account

The issue of lifestyle factors determining care hit the headlines last month when primary care trusts in Suffolk ruled obese people would not get operations like hip and knee replacements.

NICE offers guidance to the NHS on what treatments and drugs should be used after taking clinical and cost effectiveness into account.

The latest report will not be issued as general guidance across the NHS.

It is intended to help those who are formulating NICE guidelines.

Decisions about individual patient care will be left in the hands of healthcare workers.

No discrimination

The report says that NICE should avoid discriminating against patients with conditions such as diabetes which may be linked to factors such as over-eating.

However, it says that if continuation of the poor lifestyle is likely to influence the outcome of a particular treatment, then it may be appropriate to take this into account in some circumstances.

For example, if an asthma patient smokes it can reduce the effectiveness of their steroid treatment.

However, NICE chairman Professor Sir Michael Rawlins said it would only be acceptable to deny treatment because of lifestyle factors in the most exceptional circumstances.

"Almost invariably we do not expect people to take that sort of thing into account."

Professor John Appleby, chief economist for the independent think tank the King's Fund, welcomed the new guidance.

He said the health service had finite resources, and had to consider whether each treatment was cost effective.

He said: "No moral judgement is being made here. The bottom line is, does an individual benefit from treatment?

"And the issue with smoking, as with other lifestyle issues, is that you might not be able to benefit."

Age debate

NICE stresses it has already taken decisions based on age.

For instance, it recommended treatments for flu be made available for people over 65 as they are a vulnerable group, and more likely to be seriously affected.

Sir Michael said: "On age we are very clear.

"Our advisory groups should not make recommendations that depend on people's ages when they are considering the use of a particular treatment, unless there is clear evidence of a difference in its effectiveness for particular age groups.

"Even then, age should only be mentioned when it provides the only practical "marker" of risk or benefit.

"NICE values people, equally, at all ages."

Andrew Lansley, the shadow health secretary, said: "There must be absolutely no discrimination in medical care unless there are clear clinical reasons to withhold it, or clear evidence that treatment will not be effective."

Steve Webb, Liberal Democrat health spokesman, said: "Treatment decisions involving people's lifestyle should be based on clinical reasons, not grounds of cost."
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Old 12-09-05, 08:10 AM   #13
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For eating unhealthy? Nah. I wouldn't deny coverage. First of all, a lot of poor people can't afford to eat healthy. I can't remember when the last time I went into a store and found fruit I could easily afford. I get them, but then I have to eat ramen for at least two days a week to balance out the high price I pay for fruit.

Second, the FDA allows companies to put artificial flavors and crap like hydrogenated oils and other animal fats in just about every food. Our diet makes us fat because the stuff they put in the food is just fattening to begin with and soaked in saturated fats. Next time you go to the store, check and see how many food content labels start with "partially hydrogenated" or "shortening" (the trans fat). I bet the majority of what you pick up would have that towards the top of the list of the food ingredients. Those types of food just make you fat, and if the government allows them to put it in our food, they should give us the health insurance so we can seek medical attention when our health starts to decline. Why fault the poor for their food choices when the FDA makes it so that the food choices are so unhealthy for cheaper foods that the poor have no choice but to eat unhealthy?

I say deny insurance for smokers and drinkers and folks like that. You decide to smoke even though you get the warning on the side of the box, so if you get cancer, that's your burden, not mine.

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Old 12-09-05, 09:01 AM   #14
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Quote:
Originally Posted by Namenda
There are many commonalities between chronic illnesses brought on by poor lifestyle choices (smoking, drinking, drugging, inactivity, poor diet), and those brought on by uncontrollable circumstances (environment, genetics, predisposition, malnutrition, poverty). Who would be empowered to choose those worthy of treatment? Physicians? The government? Lawyers? Failure to give due consideration to all would destroy the healthcare system. It would function only for those able to pay the price of good health.
Well said, and should we really have an "I ride a bike and don't smoke, therefore I get health care and you don't" attitude? I don't think so.
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Old 12-09-05, 07:03 PM   #15
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should medical care be denied people who live in an unhealthy manner?

No, they should be charged more for insurance.

Also people who go to the doctor for little ****, like the flu, or cold, cuts scapes, sprains are the ones who make insurance cost more for all of us.
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Old 12-09-05, 07:57 PM   #16
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But, who decides what is unhealthy? Is it what you eat? Is it what you do or don't do? How are insurance companies going to keep track of who's doing what? Who is going to monitor so-called unhealthy habits? Won't that add to the cost of insurance?
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Old 12-09-05, 11:15 PM   #17
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Yeah, who decides? Who determines what criteria? This is bordering on eugenics and is fraught with moral and ethical issues.... ask the Nazis about that...

But I'm also not a fan of socialized healthcare either, people waste what they don't have to pay for. I'd like to see a base-support level, say... $1000/yr for basic coverage. Then if you have an unhealthy lifestyle and require additional services like heart-transplants and what-not, it comes out of your pocket.

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Old 12-09-05, 11:26 PM   #18
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It would sound good at first for smokers and people who refuse to exercise, but then everyone would wake up all of the sudden and realize they couldn't ride their bicycle or hike or skydive for fun. The only things sanctioned would be a drive to work, and a drive home per day, with maybe some light shopping. Yech.
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Old 12-10-05, 09:52 AM   #19
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Quote:
Originally Posted by Stacey
Yet life insurance coverage is routinely suspended for people who sky dive.
And fly airplanes. And participate in other "risky" activities.

Different story, however. You're paying someone to assume some of the risks in your life. Life insurance companies (and extremely conservative actuaries) have statistics that show that people who skydive take more risks and the companies aren't worth the possible profit from those policies.

Not saying I agree, just the way it is. I don't skydive, but I am a pilot. And as much as I hate it, we're not really "entitled" to life insurance any more than we're entitled to purchase any good or service on the market if we can't meet the conditions of the contract (typically price).

I'm surprised that more health insurance companies haven't done things like saying we'll cover you riding your motorcycle unless you aren't wearing a helmet; then you're on your own. Technically, my military medical health care can make me reimburse them if I don't wear a helmet on my motorcycle and plow in. Not sure if they've ever enforced it, but they can. They can also make me reimburse care or deny my SGLI if I kill myself driving drunk or without my seatbelt on. Yes, the military has a little more oomph behind it's rules, but if a company wants to sell you something and includes restrictions in the contract that are unsatisfactory... just look elsewhere.

For the right price, you can get coverage for anything.
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Old 12-10-05, 10:06 AM   #20
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I think this thread was started because of this: http://www.telegraph.co.uk/news/main...portaltop.html

But the issue isn't that treatment should be denied people because they caused the diseases themselves, by smoking or drinking or overeating (et c), but that the treatment would be wasted on someone who'll just go on smoking, drinking, overeating afterwards. One example was if a hip replacement should be given to a severly obese person, unless that person agrees to lose a considerable amount of weight immediately following the operation - or even prior to it. If they don't, the new hip would wear out in a very short time, and that's simply not acceptable on a larger scale, in terms of cost and effort involved, not to mention the risk to the patient every time they're under the knife.
And I'd have to agree with that, to some extent. Give people a second chance, but only if they're willing to change!
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Old 12-10-05, 10:36 AM   #21
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Given their argument, I could see why they'd deny treatment. If you give someone surgery for lung cancer because they've smoked and gotten lung cancer because of it, then they continue to smoke after the surgery anyway... it's not cost effective.

I guess they'd have to go on a case by case basis. If someone can't convince the medical doctors that their behaviors will change if they're treated for it, what's the point of treating them? It's not cost effective.

On the other hand, how do we know what they'll do after they've had the surgery? It's not like we're mind readers.

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Old 12-10-05, 11:30 AM   #22
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Unhealthy people (smokers, obese...) generally die younger and end up saving money over the long haul.
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Old 12-10-05, 11:50 AM   #23
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Originally Posted by koffee brown
I say deny insurance for smokers and drinkers and folks like that. You decide to smoke even though you get the warning on the side of the box, so if you get cancer, that's your burden, not mine.

Koffee
Thanks. Glad to know you think I should just die. Thankfully, my health insurance (though it keeps getting more expensive) doesn't think as you do. They have a couple different options - I go for the one that's cheaper if you are pretty much only going to the emergency room. Since I don't go for regular checkups or anything, that works for me...
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Old 12-10-05, 12:53 PM   #24
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I'm just saying if you choose to smoke, then it should be something you should cover, not us. I don't see the point of going through life saving measures for people who choose to partake in habits that are proven to shorten your life and cause you disease. I told the same thing to my sister- she smokes, and I certainly said to her that I have no pity for her when she gets cancer.

If I engage in harmful behavior habits, I would not expect people to feel for me or offer me options to get treatment just to go back to those harmful behavior habits. If you know you're doing something that's shortening your life span, and you choose to do it anyway, well... I got no pity for you. You know the risks. You choose to do it anyway.

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Old 12-10-05, 12:57 PM   #25
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Quote:
Originally Posted by Stacey
I'm sure there could be a denial of coverage for a broken arm while mtn biking

Da!n! I was going to say that . . really! Dang!
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