How would you replace/fix ObamaCare?

[The_Doctor]

Repeal ObamaCare, but keep the exchanges.

1. Legalize health care costs being higher if you're obese or a smoker. Skinnier people and non-smokers would get cheaper healthcare. This would give incentive to many to lose weight and quit smoking. BMI/Body fat test, you choose, and smoking is obvious. Health care costs would not go down overnight, but over time, they would go down. As said, it's currently illegal to kind of make smokers and fat people pay more (which they should. They use the system more and make it more expensive for the rest of us).

2. End state monopolies of health care organizations. Break them up. Enforce the law thoroughly and keep HMO's competitive. I'd say the maximum one could have is 30%. By enforcing competitive practices, you could keep costs down.

3. Keep the exchanges.

4. Create a national pool for high risk patients who are simply unlucky (read: non fat or non-smokers), that would be federally administered like Fannie Mae/Freddie Mac. They would in turn allow patients to pay into it. Or allow Medicaid to take them in, and expand the definition of "disability" to these people for medical purposs.

[The_Doctor]

As said, it's currently illegal to kind of make smokers and fat people pay more

No it's not. Smokers can be charged up to 150% of the rate that an otherwise identical non-smoker would be.

And while I agree that theoretically, it would be nice to make people pay more for conditions that are their own "fault," while not charging more for people's pre-existing conditions that aren't their fault, that would be really hard administratively to do.

Then that's already great; extend the same to fat people. 200% preferably, for both rates. This isn't a pre-existing condition. This is a condition you brought on yourself; being fat or smoking is a condition that leads to illness. Either stop/lose weight and get your doctors to attest to this, or start paying higher rates.

[The_Doctor]

Yeah guys, as fun as randomly attacking fat people is; it's hardly a productive or efficient way to reduce healthcare costs or obesity...

This is not random.

I'm sorry but fat people use the health care system far more than their skinnier counterparts. That's not even arguable; it's a fact. It's a fact that being overweight puts you at risk and by obvious extension, you use the system more.

It's not logical to say smokers should pay 150% but the obese / overweight shouldn't pay more. Obesity is the #1 health issue in America, and starting to treat it as as the health calamity it is is the way to go. One way to do it is to raise health care costs for the obese/overweight and provide incentive to slim down (and thus preserve their health).

Over 40% of all cancers (one statistic has it at 50%) comes from the obese. A sizable number of them will develop health complications before age 50. This will all put stress and raise costs for our health care system, when insurers pay more for a raft of fat people to get the care they need.

Taking on the obesity crisis is one way to tackle health care costs.

[The_Doctor]

To answer Crabcake categorically:

1. Overuse of sugar - end corn subsidies. That instantly would help, as well as perhaps taxing fast food and pastry shops. But really, we need to incentivize people to stay in shape. This generation's grandparents did fine, and we were fine up to the 1960s. Really, they were healthy without government incentive, but since we have a crisis, we're going to have to take some harsh measures.
2. Shoddy advice - everyone wants a quick fix. There isn't one. Proper diet and exercise is it. The shoddy advice exists because people don't want to apply themselves.
3. People in poverty have more access to food than those in the Third World. They also can prepare  cheap good food that is healthy. I don't buy that poor people can't buy cheap good food. Here, I can give you examples, if you want, that you can find in any supermarket.
4. Fat = unhealthy. That is 100% correct. The BMI test is only inaccurate in the sense that it doesn't measure body fat as accurately as a true body fat test (and the BMI test actually underestimates the body fat by a slight margin). Thin people are not necessarily always healthy but they're on balance, if they're not abusing and are eating well and exercising, they're much healthier than fat people in the long run. And they cost the system much less.

Fat people should pay more for health care and thin people less because frankly, the fat people are going to be using the system far more.

[The_Doctor]

To respond to various people in this thread.

1. Yes, weight is a measurable sign of health or ill health. The medical community is pretty clear about it - which is why they tell the obese and the overweight to lose weight. It is an accurate way of measuring most people's health in many instances and is a perfectly valid medical measurement.

2. We don't need to change ObamaCare for this. One aspect of this is that we need to see people keep the weight off. That means if you lose weight and you keep it off, eventually, you'll get that break. We don't need to worry about the fact that rate changes are annually for this particular problem.

3. Weight fluctuates but it only fluctuates five pounds. Most people are at a weight that is within 5 pounds, unless they're gaining or losing. Avoiding litigation could be easy, by limiting it legally. Simple - you spell out a procedure, where everyone (we're all required to have insurance now, right?) has to have an annual weigh in and verified by one or more doctors. That data is given to your insurer who would make the rate changes accordingly.

4. I object as a thin person that I have to subsidize the obesity crisis in America, and have no recourse. I rarely use insurance but I know that my rates will be higher because of fat people continually using it. I shouldn't have to be punished by subsidizing the behavior of others.
a. Smoking and obesity are the two most identifiable behaviors we can punish. It's also frankly the two most common behaviors, and taking them out would allow our insurance, overall, to go down. So it's legitimate to single them out. These are two high risk behaviors that we can and should definitely target. Not only that, these are the two conditions resulting from poor behavior. If you have a past history of hard drug use, I would be fine with you paying higher premiums as well.

5. Overweight people are slightly less at risk for health complications than the obese. But they're still at risk.

[The_Doctor]

To respond to various people in this thread.

1. Yes, weight is a measurable sign of health or ill health.

Here's a picture of a person who is classified as obese per BMI:

In my first post and subsequent posts I acknowledged body fat percentages as a better measure. Weight, however, for the vast majority of Americans will suffice as a measure.

By body fat percentages Arnold Schwarzenegger is perfectly healthy. Most Americans if they were at his weight would probably look very different