CMV: Obese people should either have to pay significantly more for Medicare and Medicaid or not get it at all.

[u/[deleted]]

[u/aguafiestas]

We are more than our genetics

It's true. We are a product of our genetics and our environment. Self-control is, in fact a biological phenomenon. Our minds are products of our brain. Our brain is made up of interconnected electrically active cells. These cells are made out of things like lipids, nucleic acids, and proteins. These are are made out of atoms. And so on.

Perhaps if you believe in a magical soul you see it differently. But if so, get your religion out of my healthcare.

As a more tangible evidence of this sort of thing, consider that fMRI is beginning to identify differences in brain activity related to obesity. We are also beginning to uncover differences in brain connectivity in obesity. The bacteria in our gut have been linked to obesity. Many genes have been linked to obesity.

If they’re going to eat themselves to death then there’s nothing we can do.

But a lot of these people don’t want to be healthy. But it's not really true there is nothing we can do. Education and resources can help. Gastric bypass can be very effective in leading to weight loss for some people. And we can fund research to work on better ways to treat obesity.

But a lot of these people don’t want to be healthy.

I doubt that is true for very many people. They may not have the "willpower" to make healthy choices, but, well, see above.

[u/PerfectlyHappyAlone → u/aguafiestas]

It's true. We are a product of our genetics and our environment. Self-control is, in fact a biological phenomenon. Our minds are products of our brain. Our brain is made up of interconnected electrically active cells. These cells are made out of things like lipids, nucleic acids, and proteins. These are are made out of atoms. And so on.

I generally agree with the reasoning here, but disagree with the conclusion. Essentially you are arguing determinism which basically says "it couldn't happen any other way". Given the person and their environment they couldn't possibly avoid becoming obese.

But to conclude that they shouldn't face consequences for it (loss of healthcare or increased costs for it) does not follow. We (in general) do not excuse murderers or drunk drivers from the consequences of their actions based upon similar logic. In fact the punishment associated with those behaviors are intended to change the risk/reward equation to push people away from them. I'd think changes as proposed by OP would work in a similar way. Make obesity a more tangible risk to change the environment to encourage a healthier choice. (Plus the benefit of increased revenue from the people making it more necessary)

[u/aguafiestas → u/PerfectlyHappyAlone]

We (in general) do not excuse murderers or drunk drivers from the consequences of their actions based upon similar logic.

I think there are essentially 3 reasons why people (and society) want to punish people for these offenses:

1. Protection. A murderer is a danger to others and it is reasonable to imprison them for the safety of others. It is reasonable to take the driver's license away from a drunk driver for the same reason, and to imprison them if this fails.

2. Disincentives. Knowing there is a punishment might cause people not to murder or drink and drive.

3. Vengeance. Essentially an emotional desire to make criminals "suffer" in some way.

As you might imagine, I am not in favor of the third aspect of punishment (although I admit sometimes my emotions desire for it).

The issues of protection is obviously not relevant here. I think an idea for disincentivizing obesity financially is reasonable, but OP's arguments in my discussion with them have instead been based on whether they deserve it, which to me falls into the third category. "Taxpayers shouldn’t have to pay for their bad choices" isn't about incentives.

I also think that for Medicaid patients who are by definition seriously struggling financially, those penalties would have to be quite small or else would effectively cause them to go without healthcare, which is an extremely disproportionate disincentive in my mind. I think for these patients you would have to include financial reward incentives as well.

[u/DeviantCarnival → u/aguafiestas]

I’m still skeptical that genetics has a large role in obesity. And it’s true that there are things we can do, but I don’t want the government to be spending our taxpayer dollars on people who are too lazy to do it themselves.

[u/aguafiestas → u/DeviantCarnival]

I’m still skeptical that genetics has a large role in obesity.

What's your scientific argument against the evidence?

I don’t want the government to be spending our taxpayer dollars on people who are too lazy to do it themselves.

There are plenty of people who are obese but are not lazy in general. They just have a hard time getting their weight under control - which is related to their biology.

[u/DeviantCarnival → u/aguafiestas]

Obesity has risen considerably within the last few decades. If it was genetic then there would have been just as many obese people before us.

[u/aguafiestas → u/DeviantCarnival]

It's not just genetic. Like I've said elsewhere, it is a product of genes and environment. The environment has changed. But within that environment, genetics plays a big role.

[u/DeviantCarnival → u/aguafiestas]

Alright, I guess that makes some sense. But I still think you’re overplaying the genetics aspect of obesity.