5 ms·

Well, the problem is solved. People just don't want to take enough ownership over their health to actually do it.

danharaj 9y ago
Fasts are so hard on the body and mind that it's not at all difficult to imagine situations in which people can't afford to do it. I wouldn't be able to do my job if I did an 850kcal fast for 3 months.
- metamet 9y ago
  Well, fasts aren't the only solution here. Changing your and adjusting your carb intake in order to offset insulin requirements can gradually get things back on track. Doing intermittent fasting isn't even that taxing once you adjust. I have been doing it for around 4 years and I work as a developer. My most productive hours are still in the morning, and I don't even eat until noon-1pm on most days. But to your point, yes, a drastic implementation of a clinical approach can be impractical. Fortunately there're a lot of ways to fix type 2 with diet which aren't as taxing. So the problem is solved. It's just that most people would rather take insulin than change their diet.
daxorid 9y ago
The problem is moral hazard. If we did the right thing and cut Type 2 diabetics off from health insurance benefits (or at least dramatically increased premiums), the incentive structures would align quickly. Edit: Mildly confused about the downvotes. I am not suggesting doing this to Type 1 diabetics, or any medical condition that is not the result of lifestyle choices. Having type 2 diabetes is very much a choice.
- logfromblammo 9y ago
  Okay, for the sake of argument, let's also refuse to pay for treatment for BASE jumpers and cave divers. Now let's refuse coverage to people who get STDs. Now people who smoke. Now people who don't fasten their seat belts. Do you see where that goes?
  - daxorid 9y ago
    Yes, I see where it goes. Either premiums would rise on the basis of lifestyle, or supplementary health insurance companies would pick up the slack. Your choice to smoke, have unprotected sex, or BASE jump would come with additional costs, which would be in addition to the cost of the cigarettes, wingsuits, etc - rather than being an externality which society pays. Note that we already do this for life insurance, and fully accept doing so. You cannot even get a short term policy without a blood test. Why should health insurance be any different?
    - Tiksi 9y ago
      I've had life insurance from my last two and current employers and haven't been to a doctor at all during that time, so I guess you can?
  - aviv 9y ago
    Uhm, towards a highly efficient system? Why do I need to pay the same premium as someone who eats fast food 3 times a day and downs 4 gallons of Coke and smokes in between?
    - logfromblammo 9y ago
      Yes, totalitarianism can be highly efficient, when all the inefficient people are forcibly excluded from the system. You need to pay the same as that person, so that the insurer does not have to know every tiny detail that separates the low-risk person from the high-risk person. Do you really want 24-7 surveillance tracking how often you drink Coke, and tattling on you if you smoke? Or do you imagine that the guy who dips fries in his milkshake is going to self-report derogatory information to their insurer? And do you think that you will be the one deciding which behaviors will be considered high-risk? Do you think that they will all be firmly grounded in science rather than morality or politics?
      - aviv 9y ago
        So you must also think you should pay the same car insurance premium as a guy who gets DUI's every couple of years and runs red lights? People who do not take care of their own bodies burden the system significantly more than people who lead a healthy lifestyle. It does not take a genius (or a clinical study) to figure this out. They simply should pay more for the resources they consume. As another poster commented, this already works this way with life insurance. Should my life insurance premium be the same as a person who skydives every weekend? One of the only ways to get people in this country healthier is by exposing their financial burden on the system. When you know you are paying $2000 for the same insurance your healthy next door neighbor gets for $250 - you pretty quickly figure out you're doing something wrong.
- nradov 9y ago
  Many medical insurance companies already offer premium discounts based on tested blood glucose and/or A1c levels. So we kind of already have a mild form of what you're proposing. I don't agree with cutting off Type-2 diabetics from health insurance benefits, but financial incentives can help encourage some people to make better choices.
viraptor 9y ago
Depends on what you see as a problem. Is it: technically what is the method of getting rid of diabetes in a controlled setting, or is it: how do we cure billions of people from general population, given the existing conditions of their lifestyle? Because the second one is the harder question. Currently it's solved in the same way world hunger is solved: just grow some plants and eat them, right?
xupybd 9y ago
From the view of an individual with self control you're correct. From a societal view that doesn't help. A large percentage of the population has demonstrated a lack of self control in this area. This has lead to widespread health problems. Those problems are a burden on society. Simply saying it's your responsibility deal with it won't reduce that burden. We found a similar problem with smoking. Numbers of smokers have reduced with public education plans and limitations on marketing. Perhaps there are similar things that can be done to help reduce the number of people suffering obesity related illness. Perhaps it's something that will have a net positive impact on society as a whole? There is of course a balance interfering with individual dietary choices is a slippery slop, freedom must be preserved at all cost.

Fasts are so hard on the body and mind that it's not at all difficult to imagine situations in which people can't afford to do it. I wouldn't be able to do my job if I did an 850kcal fast for 3 months.

metamet 9y ago
Well, fasts aren't the only solution here. Changing your and adjusting your carb intake in order to offset insulin requirements can gradually get things back on track. Doing intermittent fasting isn't even that taxing once you adjust. I have been doing it for around 4 years and I work as a developer. My most productive hours are still in the morning, and I don't even eat until noon-1pm on most days. But to your point, yes, a drastic implementation of a clinical approach can be impractical. Fortunately there're a lot of ways to fix type 2 with diet which aren't as taxing. So the problem is solved. It's just that most people would rather take insulin than change their diet.

daxorid 9y ago

The problem is moral hazard. If we did the right thing and cut Type 2 diabetics off from health insurance benefits (or at least dramatically increased premiums), the incentive structures would align quickly. Edit: Mildly confused about the downvotes. I am not suggesting doing this to Type 1 diabetics, or any medical condition that is not the result of lifestyle choices. Having type 2 diabetes is very much a choice.

logfromblammo 9y ago
Okay, for the sake of argument, let's also refuse to pay for treatment for BASE jumpers and cave divers. Now let's refuse coverage to people who get STDs. Now people who smoke. Now people who don't fasten their seat belts. Do you see where that goes?
- daxorid 9y ago
  Yes, I see where it goes. Either premiums would rise on the basis of lifestyle, or supplementary health insurance companies would pick up the slack. Your choice to smoke, have unprotected sex, or BASE jump would come with additional costs, which would be in addition to the cost of the cigarettes, wingsuits, etc - rather than being an externality which society pays. Note that we already do this for life insurance, and fully accept doing so. You cannot even get a short term policy without a blood test. Why should health insurance be any different?
  - Tiksi 9y ago
    I've had life insurance from my last two and current employers and haven't been to a doctor at all during that time, so I guess you can?
- aviv 9y ago
  Uhm, towards a highly efficient system? Why do I need to pay the same premium as someone who eats fast food 3 times a day and downs 4 gallons of Coke and smokes in between?
  - logfromblammo 9y ago
    Yes, totalitarianism can be highly efficient, when all the inefficient people are forcibly excluded from the system. You need to pay the same as that person, so that the insurer does not have to know every tiny detail that separates the low-risk person from the high-risk person. Do you really want 24-7 surveillance tracking how often you drink Coke, and tattling on you if you smoke? Or do you imagine that the guy who dips fries in his milkshake is going to self-report derogatory information to their insurer? And do you think that you will be the one deciding which behaviors will be considered high-risk? Do you think that they will all be firmly grounded in science rather than morality or politics?
    - aviv 9y ago
      So you must also think you should pay the same car insurance premium as a guy who gets DUI's every couple of years and runs red lights? People who do not take care of their own bodies burden the system significantly more than people who lead a healthy lifestyle. It does not take a genius (or a clinical study) to figure this out. They simply should pay more for the resources they consume. As another poster commented, this already works this way with life insurance. Should my life insurance premium be the same as a person who skydives every weekend? One of the only ways to get people in this country healthier is by exposing their financial burden on the system. When you know you are paying $2000 for the same insurance your healthy next door neighbor gets for $250 - you pretty quickly figure out you're doing something wrong.
nradov 9y ago
Many medical insurance companies already offer premium discounts based on tested blood glucose and/or A1c levels. So we kind of already have a mild form of what you're proposing. I don't agree with cutting off Type-2 diabetics from health insurance benefits, but financial incentives can help encourage some people to make better choices.

viraptor 9y ago

Depends on what you see as a problem. Is it: technically what is the method of getting rid of diabetes in a controlled setting, or is it: how do we cure billions of people from general population, given the existing conditions of their lifestyle? Because the second one is the harder question. Currently it's solved in the same way world hunger is solved: just grow some plants and eat them, right?

xupybd 9y ago

From the view of an individual with self control you're correct. From a societal view that doesn't help. A large percentage of the population has demonstrated a lack of self control in this area. This has lead to widespread health problems. Those problems are a burden on society. Simply saying it's your responsibility deal with it won't reduce that burden. We found a similar problem with smoking. Numbers of smokers have reduced with public education plans and limitations on marketing. Perhaps there are similar things that can be done to help reduce the number of people suffering obesity related illness. Perhaps it's something that will have a net positive impact on society as a whole? There is of course a balance interfering with individual dietary choices is a slippery slop, freedom must be preserved at all cost.