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About 80% of obese people with sleep apnea would be asymptomatic if they reduced to a non-obese weight. For this subset of people, shouldn't insurers (and often

About 80% of obese people with sleep apnea would be asymptomatic if they reduced to a non-obese weight. For this subset of people, shouldn't insurers (and often the Public) encourage the patient to use the free, safe, and natural solution (eating less) before being dependent on an expensive machine? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021364/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021364/

conanbatt 8y ago
People have an allergic reaction to the idea that insurance for someone obese should cost more than to someone thats not obese, even though that is actuarially correct.
- perl4ever 8y ago
  I feel like there is an obvious reductio ad absurdam. If you are obese, yes, you can expect higher costs. If you are diagnosed with cancer, you can expect higher costs. If you are on your way to an appointment to check for cancer, you are higher risk than someone who has no cause to worry. If we take the idea of discriminating against known risk to an extreme, there would never be a payout at all, because hours, minutes, seconds, or milliseconds before a claim, there is always an indication of elevated risk. If you have full telemetry from all the cars you provide collision insurance for, you can determine that someone is an unacceptable risk moments before impact. "High frequency insurance underwriting" would only be a difference in degree from the sort of discrimination people defend, but it would make the entire industry pointless. Therefore, I believe that everybody agrees discrimination against known risks must be limited by regulation or other means to make insurance viable; we're just arguing about where to set the boundary. It is generally accepted that race, religion, and so on are prohibited forms of discrimination, but that doesn't mean there is some principle that says all other forms of discrimination are ok. Furthermore, the arguments for discriminating against the obese logically apply to protected categories, so how do you reconcile that? Apart from logic, I don't understand why anyone would want to argue in favor of discrimination against people who have a tendency to be obese, even if you don't have that particular issue. There are an unlimited number of conditions a person could have that could be similarly discriminated against.
  - conanbatt 8y ago
    You are describing a world without insurance: where each incident bears its full results on the bearer. This is the situation with almost anything you do everyday: from eating to crossing the street, to wearing helmets on electric scooters. Insurance as a product is a way to manage that risk, but it doesnt eliminate it, and as a product it makes the total cost higher, as you need to pay to manage the risk. Insurance itself always bears the risk of adverse selections: it attracts those that will have higher tendencies to abuse the insurance. That is the nature of insurance, what it solves and why it requires human effort to manage, it can't be automated away: it is an economic solution. Another problem would be: some people have very expensive medical treatment and we should not as a society let them die or suffer death from it. But that problem is not soluble through insurance, that is soluble through charity and charity alone. Using insurance as a mechanism of charity is using a hammer on a screw.
    - perl4ever 8y ago
      Yes, I was describing a world without insurance. I'm saying a world with insurance and without any of what you call charity is strictly speaking impossible. And therefore the separation between insurance and what you call charity is spurious. Insurance cannot exist and solve any problem if insurers are able to discriminate perfectly, so it cannot be a matter of principle that they should be able to discriminate to any arbitrary degree. The idea that insurers are inherently justified in discriminating against poor risks is a nihilistic attack on the idea of insurance. Total information awareness would lead to perfect discrimination and the annihilation of insurance, so you cannot justify by a principled argument discrimination against those you don't like purely on the basis that insuring them is charity.
      - conanbatt 8y ago
        > I'm saying a world with insurance and without any of what you call charity is strictly speaking impossible Truly don't get this. Insurance discriminates before the fact: it's a framework to gauge risk, and collect a premium for managing it. There is no charity involved in that process.
wmil 8y ago
On a practical level you need to accept that most people trying to loose weight fail, succeeding will still take years to lose the weight, and that most of those people will suffer significant medical problems from sleep apnea in the mean time.
- GirlsCanCode 8y ago
  What's "loose weight?"
driverdan 8y ago
Not sure why you're being downvoted. If your problems are caused by being overweight you should be incentivized to lose weight and do so.
- kurtisc 8y ago
  It's not actually related to anything in the article, it poses a false dichotomy.
  - rustcharm 8y ago
    It isn't? https://assets.propublica.org/images/articles/_threeTwo400w/20181121-schmidt-inline.jpg https://assets.propublica.org/images/articles/_threeTwo400w/...
    - hnphillipj 8y ago
      That got me.
- perl4ever 8y ago
  What if your problems are caused by being depressed? It so happens that antidepressants cause people to gain weight frequently.
  - rustcharm 8y ago
    How do antidepressants create matter from thin air?
    - Karunamon 8y ago
      Don’t be intentionally obtuse. Depression is a bug in the operating system of the mind that impacts everything from motivation to hunger. Pretty hard to lose weight when just getting up in the morning is a feat of willpower and cheap, shitty food is a slightly brighter shade of grey in the dark dull shade of grey that a clinical depression sufferer has as their entire life. Ever tried debugging a program on a machine with bad RAM? It’s kinda like that.
0xcde4c3db 8y ago
> About 80% of obese people with sleep apnea would be asymptomatic if they reduced to a non-obese weight. Where are you getting this from? I didn't see anything like it in the study you linked, it doesn't match the general impression I've gotten reading other OSA studies, and it's unusual for lifestyle intervention studies to have a large number of people lose enough weight to go from obese to non-obese. Are you sure that you're not neglecting some other qualification of the population (e.g. mild sleep apnea, bariatric surgery)? > For this subset of people, shouldn't insurers (and often the Public) encourage the patient to use the free, safe, and natural solution (eating less) before being dependent on an expensive machine? No, because weight loss takes time, and there's nothing particularly safe about leaving OSA untreated in the interim. Weight loss is a fine thing to pursue for overweight and obese OSA patients, but deciding up-front to do that instead of CPAP is reckless. I agree with the authors of the study you linked when they conclude that "it is clear that treatment of OSA cannot be limited to any single strategy, but rather requires a multidisciplinary approach". Not every patient will respond to or tolerate every treatment approach, and the possibility of synergistic effects should not be ignored.

conanbatt 8y ago

People have an allergic reaction to the idea that insurance for someone obese should cost more than to someone thats not obese, even though that is actuarially correct.

perl4ever 8y ago
I feel like there is an obvious reductio ad absurdam. If you are obese, yes, you can expect higher costs. If you are diagnosed with cancer, you can expect higher costs. If you are on your way to an appointment to check for cancer, you are higher risk than someone who has no cause to worry. If we take the idea of discriminating against known risk to an extreme, there would never be a payout at all, because hours, minutes, seconds, or milliseconds before a claim, there is always an indication of elevated risk. If you have full telemetry from all the cars you provide collision insurance for, you can determine that someone is an unacceptable risk moments before impact. "High frequency insurance underwriting" would only be a difference in degree from the sort of discrimination people defend, but it would make the entire industry pointless. Therefore, I believe that everybody agrees discrimination against known risks must be limited by regulation or other means to make insurance viable; we're just arguing about where to set the boundary. It is generally accepted that race, religion, and so on are prohibited forms of discrimination, but that doesn't mean there is some principle that says all other forms of discrimination are ok. Furthermore, the arguments for discriminating against the obese logically apply to protected categories, so how do you reconcile that? Apart from logic, I don't understand why anyone would want to argue in favor of discrimination against people who have a tendency to be obese, even if you don't have that particular issue. There are an unlimited number of conditions a person could have that could be similarly discriminated against.
- conanbatt 8y ago
  You are describing a world without insurance: where each incident bears its full results on the bearer. This is the situation with almost anything you do everyday: from eating to crossing the street, to wearing helmets on electric scooters. Insurance as a product is a way to manage that risk, but it doesnt eliminate it, and as a product it makes the total cost higher, as you need to pay to manage the risk. Insurance itself always bears the risk of adverse selections: it attracts those that will have higher tendencies to abuse the insurance. That is the nature of insurance, what it solves and why it requires human effort to manage, it can't be automated away: it is an economic solution. Another problem would be: some people have very expensive medical treatment and we should not as a society let them die or suffer death from it. But that problem is not soluble through insurance, that is soluble through charity and charity alone. Using insurance as a mechanism of charity is using a hammer on a screw.
  - perl4ever 8y ago
    Yes, I was describing a world without insurance. I'm saying a world with insurance and without any of what you call charity is strictly speaking impossible. And therefore the separation between insurance and what you call charity is spurious. Insurance cannot exist and solve any problem if insurers are able to discriminate perfectly, so it cannot be a matter of principle that they should be able to discriminate to any arbitrary degree. The idea that insurers are inherently justified in discriminating against poor risks is a nihilistic attack on the idea of insurance. Total information awareness would lead to perfect discrimination and the annihilation of insurance, so you cannot justify by a principled argument discrimination against those you don't like purely on the basis that insuring them is charity.
    - conanbatt 8y ago
      > I'm saying a world with insurance and without any of what you call charity is strictly speaking impossible Truly don't get this. Insurance discriminates before the fact: it's a framework to gauge risk, and collect a premium for managing it. There is no charity involved in that process.

wmil 8y ago

On a practical level you need to accept that most people trying to loose weight fail, succeeding will still take years to lose the weight, and that most of those people will suffer significant medical problems from sleep apnea in the mean time.

GirlsCanCode 8y ago
What's "loose weight?"

driverdan 8y ago

Not sure why you're being downvoted. If your problems are caused by being overweight you should be incentivized to lose weight and do so.

kurtisc 8y ago
It's not actually related to anything in the article, it poses a false dichotomy.
- rustcharm 8y ago
  It isn't? https://assets.propublica.org/images/articles/_threeTwo400w/20181121-schmidt-inline.jpg https://assets.propublica.org/images/articles/_threeTwo400w/...
  - hnphillipj 8y ago
    That got me.
perl4ever 8y ago
What if your problems are caused by being depressed? It so happens that antidepressants cause people to gain weight frequently.
- rustcharm 8y ago
  How do antidepressants create matter from thin air?
  - Karunamon 8y ago
    Don’t be intentionally obtuse. Depression is a bug in the operating system of the mind that impacts everything from motivation to hunger. Pretty hard to lose weight when just getting up in the morning is a feat of willpower and cheap, shitty food is a slightly brighter shade of grey in the dark dull shade of grey that a clinical depression sufferer has as their entire life. Ever tried debugging a program on a machine with bad RAM? It’s kinda like that.

0xcde4c3db 8y ago

> About 80% of obese people with sleep apnea would be asymptomatic if they reduced to a non-obese weight. Where are you getting this from? I didn't see anything like it in the study you linked, it doesn't match the general impression I've gotten reading other OSA studies, and it's unusual for lifestyle intervention studies to have a large number of people lose enough weight to go from obese to non-obese. Are you sure that you're not neglecting some other qualification of the population (e.g. mild sleep apnea, bariatric surgery)? > For this subset of people, shouldn't insurers (and often the Public) encourage the patient to use the free, safe, and natural solution (eating less) before being dependent on an expensive machine? No, because weight loss takes time, and there's nothing particularly safe about leaving OSA untreated in the interim. Weight loss is a fine thing to pursue for overweight and obese OSA patients, but deciding up-front to do that instead of CPAP is reckless. I agree with the authors of the study you linked when they conclude that "it is clear that treatment of OSA cannot be limited to any single strategy, but rather requires a multidisciplinary approach". Not every patient will respond to or tolerate every treatment approach, and the possibility of synergistic effects should not be ignored.