Yet another reason for single payer.

WOW! You refer to "patients." If you are a nurse or Dr. I am appauled by your lack of empathy. Thank god I never had you as part of my health care. Obese people are the last minority that it is ok to discriminate against. Refuse to allow them to board an airplane, take away their insurance or have them pay big fines. That will really help won't it. You would not even think to do this to a Black or Hispanic person. Nor the disabled. Shame on you.

Obese people are not denied airline boarding. Sometimes they have to buy two tickets because they take up two seats.

People don't choose to be black or hispanic or disabled, but 99.9999999% of obese people are obese because of their own bad choices.

That's both ignorant and wrong. CDC Features - Obesity & Genetics

Wow! Am I glad my genes allow me to consume more than the average guy and yet keep my boyish figure. Did I read where the BMI is seriously flawed?

Did I read where insurers are doing the math and finding that the Affordable Act ain 't affordable and could well double premiums? Did I read that better than 50% of the 40 million people entering the health insurance programs will be getting hefty subsidies from the government. Hmmmmmm that means people like me are going to support this health care insurance system both from increased premiums and also by increased taxes

I am glad CVS and its insurer are apply punitive measures toward these obese and irresponsible people. Thank God they wouldn't resort to those incentive programs insuerers used in the past that rewarded people for good behavior such as the rewards program my wife's corporation sponsored wherein employees were paid up to $500 for agreeing to a complete physical including lab work, colonoscopy followed my recommendations for improvements. Better Big Brother take the lead the rest of us are incapable

I don't think CVS goes far enough; I believe in order to reduce insurance rates corporations and their insurer should:

Apply penalities to those people whose genetic makeup cause them to be obsese, mentally ill, having any physical disablility

Apply double penalities for those people who abuse prescriptions drugs, illegal drugs,

Apply double penalities for people who fail to practice safe sex and have more than 2.1 babies per family.

Apply double penalities for any people caught going in excess of the speed limit, flying in a plane or for that matter penalitie in porportion of the city they commute in highest in New York City. Los Angles lower in Butte MT

apply triple penalities if you live in the bad sections of chicago, New York Los angles because your chances of being shot are greater

Apply triple penalities for people who fail to pracice safe sex which leads to STD's

Apply quadruple penalities for people who fail to practice safe sex and contract HIV/AIDS

Now that is a definition of fairness an insurance actuary could love

What is wrong with us?

Let's be clear...the causes and cures for obesity are many. For some the genetic factor is so strong - a diet well under 1000 calories/day is the only option (short of surgery)...think that's doable 24/7/365 for the rest of your life...try it...I managed it for 3 years...then I just couldn't.

For others a moderate decrease in calories and increase in activity will produce the desired weight loss.

The problem with many of these posts and the CVS policy is that it assumes everyone falls into something closer to the second catagory.

It is in the diet industry's interest, and even the medical industry (docs, too) to assume the latter category will provide the fix. Why? Well, for the diet industry - the motive is profit. For the medical industry - it is in everyone's interest to try the least invasive option, first. If behavior modification works everyone wins.

Unfortunately, recent studies show very mixed/bad outcomes with just behavior modification. This is a report on a recent study out of Britian: Only one in 100 dieters keeps the weight off | Mail Online

What is clear here is that ignorance and prejudice are in no short supply and the unfortunate thing is that dumb opinions first manifest in corporate policy and then insidiously work their way into public policy. This de-evolution of our culture is a sad thing but as Forest Gump said - "Stupid is as Stupid Does."

Is this the same CVS that has shelves filled with candy bunnies, jelly beans, sugar cereals, greasy snacks like potato chips and faux healthy ones like popcorn with 13 grams of fat per serving, cases filled with sugared soda, high energy boosting drinks that make people's hearts race to name a few of the other unhealthy things they sell. Yeah, it's ok to sell them, but not ok to actually EAT them if you work at CVS because t hey will make you gain weight or raise your blook pressure. It seems like just working for that company can raise your pressure.
There are so many reasons for things we can't understand that I for one work hard not to judge anyone on how they look or why they do what they do.

Is this what you saw about health insurance

Health Insurers Warn on Premiums - WSJ.com

Do you really think anyone would choose to be obese? To live with shame and ridicule from the likes of you? I think not. Educate yourself on the issue.

You bet I am
 

Yes, I am a health care provider. And I am guessing you have never had SO many patients in your office who are "litterly" dying of obesity. Yes, dying. A diabetic that is so out of control that their feet and legs are falling off or have gangrene. We cannot control their insulin levels even in the hospital. Or the patient who can't walk to the bathroom even with their oxygen because their lungs don't ventilate because their abdomen is so high and pressing up on their lungs. Or they can't lay down and breathe for the same reason.

Yes, gastric bypass can be an answer for some. It has its own set of side-effects as well AND many patients out-eat their bypasses. YES out-eat them.
But the most concerning issue to all of us is the rate of obesity and at a cost of $50,000 - $100,000 a bypass (average costs including unexpected complications), how can we as a nation afford that. Would it not be in everyones best interest to eat better and maintain a healthy weight to begin with?

You think I seem heartless, unfeeling and uncaring? Do you have any idea how painful it is to watch this happening to a patient (and their loved ones). Patients that you have cared for years and warned them that their life-style choices were going to cost them in terms of pain and suffering. It hurts beyond belief to watch them suffer - the pain in their legs....sometimes I can't give them pain medicine because it will decrease their respirations which could cause death. And when they realize they are not going home.....all I can offer is my compassion and promise that I will watch over their family.

Yes, it is awful, watching helplessly as people eat themselves to an early death. I wish I never had to do it again. It reminds me of a famous baseball player who said "If I had known I would have lived so long, I would have taken better care of myself". Please don't shoot the messenger but this is what I see everyday. More and more and more obese people so that 12 of 20 patients I see everyday are on this destructive course.

...FACT.....the new Affordable Health Care Act ( AHCA) will only allow
a 3 times swing from lowest to highest premium for ANY class........

Currently a 8 times swing is generally used.
FOR EXAMPLE....
A 70 yr old male pays 8 times as much $ premium as a 21 year old male.
70 year old male pays $800.........21 year old pays $100 for same coverage.

NEW RULE...under AHCA...as written...
...70 year old male rate can only be 3 times the 21 year olds' rate.

GUESS who is going to have a MAJOR premium increases.

.....increase the 21 year olds' premium to $ 266. (up from $100)...
the insurance company will be able to charge the 70 year old the $800.

Some of those in Congress were told there IS a Forest out there...
they replied ... "no way.....there is only a bunch of trees".

I was a health care provider for many years. When I began exhibiting behaviors and feeling you are expressing I retired. Patients need a non judgemental approach to their care and you seem to have lost yours.

I don't think Suzi was being "judgmental" by stating the naked, factual reality to people here who don't get it: that it's painful for a healthcare provider to watch their patients slowly, wretchedly killing themselves with over-eating, just as it is painful to watch a person kill themselves with booze or narcotics or anorexia.

With the morbidly obese people I've known/observed, their approach to food and romancing it seems more rooted in a mental/psychological/psychiatric problem than in a physiological one.

I didn't say they choose to be obese. Overweight people make bad choices in the food and beverages they choose to consume.

So is age and almost every other aspect of human life. Some have real medical problems that are the root cause... but the majority have an overeating, poor eating habits, and lack of basic exercise problem. Yes some have a metabolism that may require more strict attention to diet and exercise. But, as they say.... life is not fair.... get over it!

Underwriting based on BMI (and rating the insured) is fairly common and the few healthcare funding providers that are not doing it soon will.

It is not about healthcare per se, it is not about genetic/tendency, it is not about moral choices... on and on.

It is about money and economics.... and increasingly... limited/strained health care capacity (money, facility, professionals, drugs, etc).... which ties back to.... guess what?

We can't have it both ways. There are several ways to reduce healthcare costs.

Everyone seems to find different approaches unacceptable... Their reason for not liking it... They think it will somehow affect them in some negative way (real or imagined).

Our current approach is extremely expensive and probably unsustainable. If it were sustainable, we will eventually choose a different approach due to the extremely high cost we will soon be enduring.

We all can expect much more of the cost of healthcare to be shifted our way... the money has to come from somewhere.

I don't see that your link provides any conclusive proof that obesity can all be blamed on genes. It only states possible genetic causes. And one thing I have learned from my studies is that genes don't act alone to cause disease. For example, a person may have a gene for cancer and never get cancer. A person may have a gene for Alzheimer's and never develop that disease.

Not to mention the fact that they have a lot of genes they are looking at that they think MAY play a role in obesity. Nothing about it is certain.

However, one thing for certain that I notice on these forums is that only a minority of people take diet-control seriously. The majority either think it's a joke or that life is to be enjoyed by eating the processed foods that they like . They say that life is too short to be depriving one's self. It's a poor attitude and they pass that attitude on to their children and grandchildren. They actually encourage poor eating habits.

So it's not so much the fault of the genes that are pased on from generation to generation but the attitudes, habits and traditions. Let's clean it up.

This explains best what I've seen. This book has been around over 20 years, and the reader reviews at the book link affirm this core problem:

“A life-changing book.” — Oprah

In this moving and intimate book, Geneen Roth, bestselling author of Feeding the Hungry Heart and Breaking Free from Compulsive Eating, shows how dieting and emotional eating often become a substitute for intimacy.

Drawing on her own painful personal experiences, as well as the candid stories of those she has helped in her seminars, Roth examines the crucial issues that surround emotional eating: need for control, dependency on melodrama, desire for what is forbidden, and the belief that one wrong move can mean catastrophe.

She shows why many people overeat in an attempt to satisfy their emotional hunger, and why weight loss frequently just uncovers a new set of problems. But her welcome message is that change is possible. This book will help readers break destructive, self-perpetuating patterns and learn to satisfy all the hungers—physical and emotional—that make us human."

See book and reviews at the link/icon below: When Food Is Love: Exploring the Relationship Between Eating and Intimacy

[ame]http://www.amazon.com/When-Food-Love-Exploring-Relationship/dp/0452268184[/ame]

Understand that the Affordable Care Act has many many tentacles and many companies are trying to "get ready" as best they can.

One article I read right before the Supreme Court decision on the act spells out a bit...


"A little-discussed ramification of Thursday's landmark Supreme Court health care decision is that it could make things harder for the nation's heaviest workers.

The decision upholding the Affordable Care Act has cleared the way for a planned increase in the penalties that employers can impose on workers who don't participate in company wellness programs and, in some cases, who don't meet certain health targets such as an appropriate body mass index. In other words, the obese may wind up paying penalties for being overweight. Smokers, too, may get hit.

The language of the penalties under corporate health plans is often written in terms of "incentives," where the "absence of a surcharge" on health care premiums is an "incentive" for employees to agree to take part in a wellness program. Read another way, that means workers who don't agree to participate have to pay a fine. President Barack Obama's health care law raises the limit on how high a penalty employers can set to "incentivize" participation in the programs, which typically consist of health risk assessments (often including blood tests), fitness classes, disease management plans and nutrition education.

Those most likely to be affected by the increase are cigarette smokers and obese people, two groups who studies show account for a disproportionately high percentage of health care spending.

Consider one current employer plan. Swiss Village Retirement Community in Berne, Ind., gives employees $500 discounts on their health care deductibles for meeting each of the following metrics, "not smoking, having a BMI of 27.5 or less, a low-density lipoprotein cholesterol level (LDL) of 130 milligrams per deciliter or less, and blood pressure of 130/85 or less," according to the Kaiser Health Network. Those who don't reach the goals but participate in the program are given $250 discounts. Those who don't participate at all pay full price.

But studies show that health care plans offering rewards, like the one at Swiss Village, are rapidly giving way to plans that offer rewards and assess penalties. According to a report from benefits consulting firm Towers Watson, which was cited in Forbes, 38 percent of employers expect to have such penalties in place by the end of 2012."

Health Plan Costs For Obese And Smokers Could Rise After Supreme Court Ruling

Lots of changes on the horizon and keep in mind that those in congress who passed this did not read it so expect changes as it becomes uncomfortable for those same folks who may lose votes because of this piece of legislation.

These practices have been going on in the private industry for years. Nothing new... unless of course you are talking about government funded programs!

Besides, it is not a penalty, it is called underwriting and rating. Common procedures in the insurance industry... always has been!!!!

Why shouldn't the government adopt practices that are common in private industry? Would you rather they jack up premium across the board for everyone?

I am not passing judgement on anyone or anything. I am simply stating that this companies actions will not stand alone. I might add that the law if you read it makes punishment instead of incentive the action word.

If you read todays NYTimes, I think this law is not getting to law very easily as the health costs are getting higher and higher

For clarification, as I understand it, CVS employees could gain incentives on their health care in the past and those who did not do what was asked just got NO incentives.

NOW....they will pay......

"A new policy by CVS Pharmacy requires every one of its nearly 200,000 employees who use its health plan to submit their weight, body fat, glucose levels and other vitals or pay a monthly fine.

Employees who agree to this testing will see no change in their health insurance rates, but those who refuse will have to pay an extra $50 per month — or $600 per year — for the company’s health insurance program. All employees have until May 1, 2014, to make an appointment with a doctor and record their vitals.

“The approach they’re taking is based on the assumption that somehow these people need a whip, they need to be penalized in order to make themselves healthy,” Patient Privacy Rights founder Dr. Deborah Peel said."

http://abcnews.go.com/blogs/health/2...ll-pay-a-fine/



Critics are calling the policy coercion, and worrying that CVS or any other company might start firing sick workers."


My only point was that this company is not alone in changing the landscape and quickly as the law will force them to punish instead of reward and that the law, if you read it unlike those who passed it, you will find a number of changes on the horizon for everyone !

NO JUDGEMENT...JUST STATING FACTS that save the surprise on what CVS is doing for maybe the other costly items to come !!!

Again, not passing judgement ...simply calling to attention that lots of tentacles to this act that most have no read and will not until it hits them int he pocket book or some other way

Cisco Kid: I have subscribed to WSJ for many years and Yes the article is one of many the Journal published.

I am sick and tired of the government interference

I am hoping this is not considered political....it certainly falls under current events as it may be one of the most serious problems facing the country, but with the conversation about CVS, it appears that many have not read about this bill and I implore you to read because you WILL be shocked as these things begin to take affect and it may behove you to understand WHY all is happening.

Keep in mind that TODAY, the Senate voted to not allow an ammendent proposed to keep illegal immigrants who may get a green card from receiving government health benefits. We are not speaking of folks who came legally but those who are here now illegally for whatever length of time and it appears our Senate would like to reward them with federal healthcare immediately upon getting "legal".

While companies like CVS struggle to meet the mandates and costs of the bill, imagine the cost when immigration reform is introduced because this bill had NO cost for them in it thus the already heavy taxes proposed will not be sufficient, and the folks in this class of illegals represent a large portion of the unemployed.

Again, the thread questions CVS, and this is just the beginning of lots of ramifications. CVS is simply doing what they need to do.

This is probably better served on its on thread on this bill, but the questions on CVS raise a very serious point and that is that we, the citizens of this country have no idea of what is ahead as a result and I applaud CVS, perhaps not for the contents of their rules, but their foresight in getting prepared.

"The Senate’s bipartisan immigration working group split along party lines during a contentious budget vote to prevent illegal immigrants who receive legal status from receiving federal health benefits.

The Senate early Saturday morning defeated the amendment to the budget resolution which would have put the Senate on record as opposing access to health care under Medicaid or the Affordable Care Act for undocumented immigrants who get a green card."

Immigration Vote Splits Gang of 8 : Roll Call News

Here is one example of something required by the bill but never funded and someone has to pay...

"WASHINGTON — One of the biggest threats to the success of President Obama’s health care law comes from shortages of doctors, nurses and other health care professionals. But a 15-member commission created to investigate the problem has never met in two and a half years because it has no money from Congress or the administration. "

http://www.nytimes.com/2013/02/25/he...t-waiting.html

This bill has many many redeeming qualities but was very ill conceived for the wrong reasons and I submit that the CVS news is simply the tip of many more surprising things to occur.

The liink from CISCO KID also addresses some of the costs to come......and if you didnt read the link, here is an portion and I hope that all of this makes folks actually find out what else besides CVS is coming.

"Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law, with the nation's biggest firm projecting that rates could more than double for some consumers buying their own plans."

By the way, my links and CISCO's link are NOT old news...from TODAY !

Hey, why not extend the concept to Medicare? These are valuable tax dollars - any poor health practices should exclude you from receiving these funds. Smokers, drinkers, and the obese should be put on a program and correct their poor health practices, or their co-pays should be adjusted upward. Moreover, folks who didn't work and pay into the system should be denied benefits even though their spouse paid in as the spouse only paid for himself/herself. Also, the last 12 months of life use a disproportionate amount of Medicare resources. I say - cut'em off.

Great post! I think the insurers should first have CVS rid their shelves of anything that could in any way contribute to a poor choice.
The empty shelves and loss of revenue would put them out of business!

To all you folks out there who feel you have the right to critique everyone else on their choices, please check your own first.
It may not be smoking or eating choices that are your downfall, but we are all human and we all have our weak points.
All that angst and stress is just as negative for your personal health as some of the other vices mentioned here. What's that about "Let he who is without sin cast the first stone."
Y'all need to relax and smile some! You will feel a lot better for it!

I agree with Jebartle
Fit and healthy workers should get the lowest price and costs should be added for every vice and problem a person has. Its genetics that a person has a slow metabolism and their body converts everything to storage (fat) BUT is not genetics that makes a person over eat. All us people in the villages shouldn't worry about the new health care laws as we will be triaged anyway.

The "pay a fine" characterization wording is inflammatory and misleading. A headline grab by journalist that have nothing better at this time to write about.

It should read, if you choose to not provide the information for underwriting purposes so the insurance plan can set your premium rate, It will be assumed that you are at higher risk category and will be charged the premium rate from our high risk premium table. Higher risk people will pay $50/month more.

As I said earlier, what CVS is doing has been implemented in different variations for well over 10 years in company benefit plans. BMI, Smoking, etc. Providing Glucose level, some companies wellness programs go about that in different ways. Go to buy a private insurance policy and see what happens... It is not uncommon to require a full physical (depending on the coverage).

If it is illegal, I am sure there will be a court battle. There probably already has been cases in the past. But with the recent changes in the law... maybe the boundaries will be tested again.

This is the American System evolving and trying to control costs. None of us likes change... especially changes to the status quo where it requires something of us that might appear to be negative in someway.

All I can say is you better get used to change... there will be more of it.

One of the big changes is the attempt to proactively shift from disease management to health management for certain well known health problems.

It really is about money and economics. And the limited/strained capacity of our medical system.

Consider saving your outrage for the "potential" of large scale workplace abuses until they surface. We quite a number of laws and regulations for that sort of thing in place today.

Instead, you should be outraged at the cost of health care in the US and the fact that we are less healthy and have shorter lives than the rest of the developed countries. Look at the statistics on health by country and the cost of health care vs GDP per capita of developed nations.

Before we get too ahead of ourselves, let's see if we can preserve the precieved strengths of our American system and lower our costs too.

I think I am supportive of this posters concepts, but I'm also apprehensive about where such a process takes us . Should we not also charge higher premiums for risky behavior ? How about skiing, flying, sky diving, motorcycling, travel to foreign countries or even riding on streets with golf carts. These could also be assumed to carry greater health(accident) risks. Where will this take us?:duck:

Probably because the current federal statute for Medicare prevents it from happening.

But... anything that is not illegal is probably fair game. Who knows, they may end up changing the law.

For healthcare in general... I expect to see more lifestyle based underwriting for health care coverage. But some situations are not practical to implement or the cost savings do not cover the implementation cost.

Once one gets past the biggest issues of basic affordability and not being denied coverage... the question is who pays?

Since increasing capacity pushes the cost to everyone... ways to reduce the growth of capacity reduces overall cost. Stated a different way, may be the difference between someone getting in to see a doctor in a timely manner.

But for Medicare... the program appears to not be sustainable in terms of current funding. It will be another one of those "who pays battle".

What many do not realize (or refuse to realize) is that without medicare, old people would have no coverage. Insurers would exit the market... like flood insurance. If insurers were forced to stay in the market by law, very few would be able to afford the risk adjusted premium. I suspect most would be forced to settle for catastrophic major medical and go it on their own. The only reason retirees have employer based retirement healthcare coverage at all is because employers know those folks will shift to Medicare. Otherwise most all employers would would abruptly end those benefits... go the way of pensions.

For Medicare, I think a balanced approach should be taken. Every younger person (who lives) will eventually need coverage at an old age so they pay a little more into the system while they are young (however it is implemented). Us oldsters that can pay more for our coverage will have to do that as well. Fair is fair and somebody has to pay for it.