Health care policy discussion thread!

[DalNeuron]

i think that those who smoke and are obese (due to lfiestyle choice) should be forced to pay up 30% of the OHIP fee to the doc/hospital (this would be in addition to the fee/visit covered by OHIP).

 

Where then do you draw the line between obeisity that is "lifestyle choice" and a clinical disease? That's a tough one, and in my eyes is discrimination. Smoking is in the same boat.. they have a disease like any other, except in their case, the disease forces them to smoke cigarettes... Charging patients with these problems extra doesn't seems fair to me... the already decreased life expectancy, increased chance of heart failure and diabetes etc isn't enough? This is using the stick instead of the carrot.

Why not offer incentives to doctors who can show that they've encouraged their patients to lose weight or quit smoking??

[Alastriss]

Where then do you draw the line between obeisity that is "lifestyle choice" and a clinical disease? That's a tough one, and in my eyes is discrimination. Smoking is in the same boat.. they have a disease like any other, except in their case, the disease forces them to smoke cigarettes... Charging patients with these problems extra doesn't seems fair to me... the already decreased life expectancy, increased chance of heart failure and diabetes etc isn't enough? This is using the stick instead of the carrot.

Why not offer incentives to doctors who can show that they've encouraged their patients to lose weight or quit smoking??

 

not as tough as it actually is, yet your concern brings up a solid point.

as for the punishments the bring upon themselves, no it isnt enough.

THey choose to reduce their life expenctancy, why should the other person who is staying healthy suffer?

U cant take down other people with on on the excuse that ur also taking urself down.

 

Obesity related problems, prader willi and diabetes can be linked to clinical conditions. Eat a mcchicken 3 times a day cuz u like the taste or have a few gin and tonics cuz u enjoy them is however something you ought to be charged for.

 

What you said, last point, GOOD! i love it. offering incentives to doctors. i believe the UK has a system like that..doctors get paid moreif their patients are healthier in the end!

 

nice thread keep it goin

[Wolvenstar]

(sorry I have been gone so long, I wish I could have been there for the earlier debates.)

 

 

I have to agree with vallinar and his comment on having those who are obese/smoke should have to pay extra for their problems.

 

It is really easy to draw the line on whether obesity is a disease or a lifestyle choice. If you have an actual disease/condition that prevents a person from being a normal body weight then yes, they should have to pay. There are diseases out there that cause obesity, I knew a really lovely woman who used to be so pretty until she got sick. Then she became obese, she knows that she will not ever be able to go back to the bodyshape she used to be at, yet she still goes to the gym and tries to stay healthy. Just as I wouldn't expect someone who is missing both their legs to be going to the gym to stay healthy.

 

Frankly if someone made poor health choices in their past and are obese now, they need to do the work to lose the weight. Depending on how far along they let themselves get, they need to work harder to lose the weight. I know I used to be fat, until I decided to suck it up and get myself in shape. It took me five years, but now I am in great shape, and am an athlete. Just because people don't get any results quickly or are not willing to put in the effort required doesn't mean that it is a disease.

 

The same with smoking, It's a mental thing, and it requires willpower. I smoked in highschool until I decided to get into shape, and I realized how bad my lungs were. I quit cold turkey. I don't expect everyone to quit cold turkey, but there are patches and gum and other things to help them. It literally is a matter of willpower when it comes to quitting smoking, or losing weight (unless you have an actual disease/condition). People who say that it is impossible for them to quit or give up on losing weight because they think it is impossible are just weak. We should be forming more programs to promote wieght loss and smoking cessation.

 

As people we are sympathetic to those who are unhappy or struggling but that doesn't make it right to just give them the easy way out. The health problems that are due to obesity/smoking are their punishment for not taking better care of themselves and they should have to pay for it. Not everyone else. Allowing them to receive free treatment for what they have done to themselves is the equivalent of telling people that it is ok to smoke or be obese.

 

 

If fact I would be strongly tempted to add other groups into this category of having to pay for treatment when they have damaged their own bodies.

 

 

(perhaps someone should open a new thread to discuss this topic, seeing as how this thread was originally discussing whether health care should be private/public/hybrid)

[Wolvenstar]

So I wanted to also continue the talk of private/public/hybrid health care, because I believe this is the most important issue, as our health care as it stands is a failure. While this online message board does not decide policy, maybe one day one of us will be in a position of influence, or something.

 

As to what begaster said. I want to give you congrats on your willingness to state your beliefs. I also like how you said it as bluntly as you wanted. why? Because your not actually talking to a patient, and when discussing ideas people should be allowed to speak how they feel comfortable (unless your talking to a patient/family member of patient) I knew as soon as I read it people would get pissed about it. I believe that what you said about the grandmother comment deals more with a debate on whether or not it is right to allow people to exist in a vegitative state, and you are right to a point. I do not believe it is right for people to keep the bodies of their loved ones rotting in a vegetative state, in my mind it is dis-respectful to the memory and/or soul of the one they love. At the same time I am leery as to how much automony you can take away from a patient.

 

Sure I would rather have my doctor make decisions on my health rather than my mother. Compared to a doctor, my mother is a dingbat when it comes to medicine and treatment. But if the patient has less autonomy does this mean that anyone working at the hospital as more power or just the patient's doctor. I wouldn't trust a nurse with stitching me up properly, much less my life. You just have to look at some of the idiotic mistakes nurses have made in the emergency. My girlfriend knows of a woman who miscarried in the waiting room because the nurse wouldn't send her through. I watched an elderly man almost die because he was having trouble breathing and actually stopped in the waiting room, for god's sakes it was obvious to anyone looking at him that something was seriously wrong, and yet this 65yr old (or something close to that) nurse/secretary couldn't care less. So while I trust doctors to make a better decision on my health than my parents, I would sooner trust a retarded monkey with my health than a nurse.

 

 

Some people have suggested that the current taxes should be raised so that there is more money for the public health care system. Sure a political party could make legislation on raising taxes but then the other political parties will use this to throw out the other political party, and the party will receive less votes in the election and gain less seats, which means they have less power. Which is why this will never happen.

 

 

As to what someone said about my orignal suggestion on the public/private hybrid theory, and on how it will never work because the government isnt hiring doctors and there is already a shortage. You need to understand how the government works. Politicians dont want to do anything, you pretty much have to stab them in the ass with a pitchfork to get them to do their jobs.

 

Right now yes there is a shortage of doctors, but not a large enough one. People aren't complaining enough to force politicians to do something about this. But if what I said happened there would be an even larger shortage of doctors, and this is something that the government can't ignore, thus it would force politicians to take action and encourage schools to expand their medical schools, set up programs for drawing doctors from other countries to Canada, etc.

 

 

 

Yes as others have said the public sector should be able to provide the kind of health care and legitimate wait times that this country needs, but it can't. So either we have to figure out a new way for the public system to run so that it can do this, or we have to think about adding a private health sector, to compliment, not compete, with the public health sector.

 

So many people have this fear that if you try to add a small private sector to Canada, that the entire health care system will turn private overnight. This is irrational. A private health care tier along with the public one, will benefit Canadians greatly. It just requires very strict regulating and constant observance to keep the private sector from damaging the public sector.

[ccc]

I just wanted to give my view on the obesity/smoking debate.

 

I believe that you cannot charge smokers/obese people more for health-care simply because they are obese/have lung problems,etc. I think this shakes the very system of equality that our system is built upon. Everyone should be given equal access to health-care, and if someone has made a mistake in their life by taking up smoking, are you going to punish them? No! The doctor's role is to always act in the best interests of the patient and giving worse treatment to a patient that is responsible for their own poor health is not doing so. Are you going to charge a drunk driver more for his/her hospital stay because he/she was stupid enough to go drunk driving?!

 

On a another note, I realize that there are cases when priorities have to be set. Ie. Two patients need a lung transplant, one of them is a smoker - who gets it? In this case, I still think that both patients should be treated equally and prioritized on criteria ONLY relevant to their SURVIVAL and how well they can make use of the organ, not on their past life-choices/mistakes they may have made. In fact there are so many factors involved in a situation with a smoker/obese person that I don't think we can arbitrarily say "smokers need to pay more for X" (disease/genetics as a factor).

[kimmiegibbler]

 

So many people have this fear that if you try to add a small private sector to Canada, that the entire health care system will turn private overnight. This is irrational. A private health care tier along with the public one, will benefit Canadians greatly. It just requires very strict regulating and constant observance to keep the private sector from damaging the public sector.

 

 

The fear is pretty valid, and not just in a slippery slope sense. If you research into medicare's precarious position within WTO regulations, its not hard to see how starting to dismantle the Canada Health act and allowing more private services would leave medicare vulnerable to further corporate penetration.

[kimmiegibbler]

I don't think it is ethical to charge obese people and smokers more for healthcare, but I do think that there should be more tax on junk food (candy, chips, pop etc), and cigarettes and all that money should go into healthcare.

[Vallinar]

I don't think it is ethical to charge obese people and smokers more for healthcare, but I do think that there should be more tax on junk food (candy, chips, pop etc), and cigarettes and all that money should go into healthcare.

 

I don't see whats unethical about it. WE aren't charging them because they're sick, but just be they choose to smoke or adopt an unhealthy lifestyle. I think its more unethical for such ppl to ruin their bodies and then drain and leach of the healthcare system while not doing anything for themeselves.

[Vallinar]

I just wanted to give my view on the obesity/smoking debate.

 

I believe that you cannot charge smokers/obese people more for health-care simply because they are obese/have lung problems,etc. I think this shakes the very system of equality that our system is built upon. Everyone should be given equal access to health-care, and if someone has made a mistake in their life by taking up smoking, are you going to punish them? No! The doctor's role is to always act in the best interests of the patient and giving worse treatment to a patient that is responsible for their own poor health is not doing so. Are you going to charge a drunk driver more for his/her hospital stay because he/she was stupid enough to go drunk driving?!

 

On a another note, I realize that there are cases when priorities have to be set. Ie. Two patients need a lung transplant, one of them is a smoker - who gets it? In this case, I still think that both patients should be treated equally and prioritized on criteria ONLY relevant to their SURVIVAL and how well they can make use of the organ, not on their past life-choices/mistakes they may have made. In fact there are so many factors involved in a situation with a smoker/obese person that I don't think we can arbitrarily say "smokers need to pay more for X" (disease/genetics as a factor).

 

 

transplants are a non issue. It shoulld be limited ONLY to extra charges for simple being a smoker or obese, but NOT for being sick as a result of their choices. The typical criteria (ie based on survival, beneficence etc) would still be applied in a transplant case.

 

Seriously, there needs to be a way of reducing the strain on the system and this strain comes by and large from obesity and smokers.

[Wolvenstar]

On a another note, I realize that there are cases when priorities have to be set. Ie. Two patients need a lung transplant, one of them is a smoker - who gets it? In this case, I still think that both patients should be treated equally and prioritized on criteria ONLY relevant to their SURVIVAL and how well they can make use of the organ, not on their past life-choices/mistakes they may have made. In fact there are so many factors involved in a situation with a smoker/obese person that I don't think we can arbitrarily say "smokers need to pay more for X" (disease/genetics as a factor).

 

 

Now I am not certain on the subject, but wouldn't the fact that someone is obese/smoker/alcoholic/crack addict. Factor in to the decision of the doctors as to who gets an organ.

 

Do you really want to say that a person who smokes 2 packs a day isn't in any way affecting their body? Or it isnt the fault of a 40year old single alcoholic that his liver is failing? Oh yes indeed perhaps he does have a disease, perhaps his genetics lead to a susceptibilty of liver failure.

 

Or perhaps you would like to say that the 900pound man who gets hauled off to the police department once a month deserves a new heart just as equally as a mother of 3? Or could you tell me that his obesity won't affect his survival rate.

 

 

 

If a smoker has damage to their lungs, yes many things may have contributed to the damage, but it was the 2 packs a day that did the worst damage.

 

Yes perhaps its was many things that lead to the obese person whose heart is so clogged with cholesterol that they need a new one, but i bet their lifestyle that lead to their obesity caused the most damage to the heart.

 

How in the world can you say they should be treated equally in transplant cases? How in the world can you say that smoking/obesity/alcoholism/crack addiction DOESN'T affect ones survival rate???

 

 

 

 

 

Now you said that:

 

"The doctor's role is to always act in the best interests of the patient and giving worse treatment to a patient that is responsible for their own poor health is not doing so"

 

charging them is not giving them worse treatment, charging them is making them pay for that level of treatment.

 

 

The other thing you said:

 

 

"Are you going to charge a drunk driver more for his/her hospital stay because he/she was stupid enough to go drunk driving?!"

 

 

No unless you are extremely lucky, or the cop that comes to the hospital is extremely stupid, you usually do end up paying. You pay large fines, revoking of your drivers license and often enough jail.

[kimmiegibbler]

I don't see whats unethical about it. WE aren't charging them because they're sick, but just be they choose to smoke or adopt an unhealthy lifestyle. I think its more unethical for such ppl to ruin their bodies and then drain and leach of the healthcare system while not doing anything for themeselves.

 

First off while there are some people who truly don't care, most overweight people i know are always on some diet. I am skinny and have no idea what they are going through, and if you have never been obese neither do you. It is believed that there are neurochemical forces at work, genetics play a part, as well as addiction. So to make a blanket statement that obese people are doing nothing for themselves, simply isn't true. Some aren't, some are.

 

There is also the issue of upbringing. Say a child grows up with two obese parents and by the time they are 18 they are morbidly obese, has type 2 diabetesetc. So do they start paying healthcare premiums when they barely stood a chance? Do you force them to drop 200 pounds right away?

 

There is also the issue of proving that their condition came from their behavior. Yes it is common knowledge that all these behaviors are health risks, but you can't say for certain if the behavior caused the disease in some cases. My friends dad died of lung cancer, he had been smoke free for six years when he was diagnosed, he had also been exposed to asbestos and various other effluents in his work place.

 

There are also the practical issues of enforcement. Someone could conceal they are smoking, lie about quitting etc. Are we going to have investigators following these people around seeing if they go to burger king or light up?

 

I am not saying that they shouldn't pay for their choices, I just find it more practical and and ethical to have them pay at the cash register. Junkfood is terrible for everyone, and it effects all of our health, obese or skinny to a point, so shouldn't we all pay a price when we decide to engage in something unhealthy? Seems unfair that a genetically thin person should be able to eat mcdonalds and drink a 2L of coke each day and not pay, but the person who has been fat since they are 5 does. It may also deter people from poisoning their kids with high fructose corn syrup, setting the stage for a lifetime of health issues. Right now it is much cheaper to buy garbage food then healthy, and that is just wrong.

[ccc]

Wolvenstar,

 

I agree with you, that if the smoker is still smoking, then we can say that this will affect his/her chances of survival. With that, I agree that the non-smoker should have priority. However, what I'm arguing is that an ex-smoker that has given up smoking and now, has the same chances of survival as the non-smoker after receiving the lung transplant - I think both patients should be equally prioritized and the smoker not punished. My wording might have been a bit misleading.

 

In regards to your other point - yes, the drunk driver has to pay fines and will lose his drivers license. But that's not really what I'm getting at. I don't believe the hospital should charge the drunk driver more for a hospital bed, for example, simply because he is a drunk driver. We are not the justice system and it's not our responsibility to charge or punish people. The police can do that, but I think that doctors should only focus on saving patient lives.

[Rarkon]

On the obesity issue:

 

It may be true that some people eat unhealthy foods because they simply like the taste. However, eating unhealthy foods is much cheaper than having fresh vegetables and fruits. Therefore, not everyone who is obese will be able to pay the money to change their lifestyle. An alternative solution, to penalizing obese people, would be to reduce to cost on health foods. This way you're reward the good decision and not punishing the bad one. I think this is far more humane.

[Wolvenstar]

Rarkon - i agree with you that healthier foods should be more affordable and that people of all income bracts should be able to afford healthy food. While the honey attracts more flies strategy is good, I think that it would cause an even stronger shift for there to be both punishment and reward.

 

 

CCC - I agree that an ex-smoker should not be penalized for having smoked in the past.

 

 

Kimmiegibbler:

 

Alot of times obese/overweight people are just on a diet or are just trying to exercise. There are many factors which create problems for those who are overweight, they might have created a poor diet plan that actually hinders rather than helps them, they might not exercise enough, or at a high enough intensity. The fact is that the more obese a person is the HARDER they have to work at losing the weight. But they can still lose the weight.

 

While there are some who have a genetic disposition towards being obese, this is included in the minority i had talked about earlier (fewer than 20% of obese/overweight people have these genetics, or a disease, or a condition than prevents them from losing weight). However you can not take a person's word for it, because more overweight/obese people will say that they have this, and really they dont.

 

Secondly, you don't have to prove that their conditions are from their behaviour. You only have to prove that their condition is not due to a genetic predisposition or a disease or another condition. These conditions which cause obesity/overweightness are usually not that difficult to diagnose, so it becomes a matter of eliminating the possibility that they have this genetic predisposition/disease/condition. Because if it isnt from those then it must be from lifestyle (or aliens lol).

 

As for other conditions, it is possible to tell whether someone is a heavysmoker/smoker/non-smoker. Their are other signs that show what a person's habbits are in terms of smoking or drinking. You don't have to follow these people to see if they are smoking or drinking alot. Smoking and drinking affect the body is certain ways, and it would be easy to perform a few simple tests and the results would tell you how much ciggarette smoke or alcohol they expose themselves to.

 

The only problem this could create is someone working in a smoke-intense enviroment like a casino or a bar. But since Canada has been taking steps to restriction/remove smoking from public areas this is no longer a problem.

 

 

It's not always junkfood that is the predominant food for overweight individuals, many just eat many more times per day than the average person and/or eats larger helpings. I lived with an obese woman last year who had six meals per day, not that bad if they were smaller meals, but each meal was equivalent to the amount of food a person would eat during a large dinner meal. The woman spend over $100 a week on food, not to mention drinking large amounts of alcohol on the weekends (which is calorie filled depending on type of drink). Now mind you, people do need a certain amount of grains/dairy/etc so it isnt fair to raise the tax on these kinds of foods.

 

I was overweight as a child, but my mother also fed us pasta every night along with some sort of meat and either rice/potatoes/salad. That along with large breakfasts and lunches pushed me into being overweight even though I played several sports.

 

taxing junk food will undoubtabley cause a small decrease in overwieght/obese people, more so in children than adults, but it would not be that significant of a decrease. I am not saying this is a bad idea, only that it is not going to fix the problem on its own.

 

and while a genetically thin person might be able to eat more unhealthy foods, they tend to have their own medical problems to contend with. Besides this just give those who are genetically predispossed to being thin a chance to become more disciplined and strengthen their willpower, pretty much becoming a better person just by keeping themselves healthy.

[Madz25]

On the obesity issue:

 

It may be true that some people eat unhealthy foods because they simply like the taste. However, eating unhealthy foods is much cheaper than having fresh vegetables and fruits. Therefore, not everyone who is obese will be able to pay the money to change their lifestyle. An alternative solution, to penalizing obese people, would be to reduce to cost on health foods. This way you're reward the good decision and not punishing the bad one. I think this is far more humane.

 

I agree. I havent read the previous posts so I'm sorry if this has been mentioned already. An alternate solution would be to have a "fat tax" - taxing foods based on their fat content.

 

We've had a few lectures outlining the seriousness of obesity. One of the physicians is really passionate about the problem. He showed us an animated map of the US that tracks the obesity trends. It's scary. If any other disease was spreading the way obesity has, something would surely have been done about it.

 

Here's a link to a similar map. Watch the picture.

http://www.dhss.mo.gov/Obesity/

[kimmiegibbler]

taxing junk food will undoubtabley cause a small decrease in overwieght/obese people, more so in children than adults, but it would not be that significant of a decrease. I am not saying this is a bad idea, only that it is not going to fix the problem on its own.

 

I don't think it would either. I agree the deterrent effect would be small. However it would create a large source of revenue (arguably larger than charging a fee for service to obese/smokers since the entire population would be paying into it) that can be put towards health care as well as preventative medicine programs that can address the problem.

 

If it directly has the greatest effect obesity in childhood, that in my mind is the most important time to effect a change.

 

I don't see how charging someone for healthcare because they are overweight or smoke will fix the problem either. People with addictions and compulsive behaviors aren't necessarily effected by financial deterrants. Gambling, drug addicts would beg borrow and steal to keep doing their thing.

I don't think that the obese or smokers would be any different. Already smokers pay a ridiculous amount for cigarettes, so why would paying more for health care make a difference?

[kimmiegibbler]

I agree. I havent read the previous posts so I'm sorry if this has been mentioned already. An alternate solution would be to have a "fat tax" - taxing foods based on their fat content.

 

I think there should be a (extrinsic) sugar tax too. The fat tax be for trans and saturated fats I assume since there are those good fats. Mmmm I love me some olive oil and avocados.

[kimmiegibbler]

 

Secondly, you don't have to prove that their conditions are from their behaviour. You only have to prove that their condition is not due to a genetic predisposition or a disease or another condition. These conditions which cause obesity/overweightness are usually not that difficult to diagnose, so it becomes a matter of eliminating the possibility that they have this genetic predisposition/disease/condition. Because if it isnt from those then it must be from lifestyle (or aliens lol).

 

As for other conditions, it is possible to tell whether someone is a heavysmoker/smoker/non-smoker. Their are other signs that show what a person's habbits are in terms of smoking or drinking. You don't have to follow these people to see if they are smoking or drinking alot. Smoking and drinking affect the body is certain ways, and it would be easy to perform a few simple tests and the results would tell you how much ciggarette smoke or alcohol they expose themselves to.

\

 

 

I think all these extra tests and especially any genetic testing would cost the health care a great deal.

 

Even without a genetic predisposition, I think the social influence (i.e. the home you are born into) predisposes someone to obesity. Either way, changing your lifestyle isn't a simple task, as obesity is thought to accompany changes in brain chemistry. There are also those who are obese because they have an eating disorder (compulsive overeating). So do we charge bulimics and anorexics more for health care? This brings up questions of fairness. Shouldn't we charge everyone who's own behavior cause them to be sick or get in an accident and need healthcare. How is it fair to isolate these people and their addictions/bad behaviors? Do we charge prostitutes or other groups who engage in risky sexual behavior more when they get stds? Do we charge someone who has a record of speeding more when they get in a car accident? Do we charge someone who refuses his or her recommended colonoscopies or mammograms when they present with advanced cancers?

Regardless of the size of the group it is unfair to charge one group for their risky behavior that cause them to need healthcare and not others. Also regardless if someone is to blame for their condition I think it is unethical to impose barriers to healthcare which under our health act is a basic right to all. Not to mention that these people need it the most, and seeing a doctor may help them overcome their vices, so it makes no sense to deter their access with a charge.

Irregardless of all of the above, I think as a rule of thumb I think its better to address a problem early on than when the person needs to access healthcare. We should be instituting earlier intervention programs not imposing cash deterrant which would likely prove to be any deterrent at all when someone lights up for the first time or is already addicted. If fear of death doesn't stop the behavior, why should a bill?

 

I think taxes on commodities that are proven to compromise health is a better way to raise money for these intervention programs and to recoup spending on the treatment of related diseases, rather than institute fees for services for certain groups of people.

[Wolvenstar]

Yes, your point is exactly the one I am trying to say, but I am using it in for the opposite arguement. We could create new taxes on "junk" food and everyone who buys some ever would have to pay more for it, even those who are not obese. I say that it is not fair that those who keep their bodies relatively healthy should not have to should the burden imposed by those who smoke/are overweight/alcoholics, etc. Should the general public have to pay extra because a minority of the population decides they want to puff on cancer sticks and end up needed operations for it? If a young male continously goes out to the bar every weekend and overindulges resulting in a trip to the hospital should the public have to pay for his fees too? Is it ethical to have the public pay for the care given to those who couldn't give a damn about their health?

 

On one side yes, public healthcare is about providing medical necessities to everyone (and/or anyone) who requires it. But just like the policies of a government, the healthcare system effects everyone, and thus is must cater to the needs of the majority. you don't see the government allowing smokers to smoke in public areas because they want to?

 

On an individual basis it would be great to provide everyone with the exact same level of healthcare, for the exact same price (nothing). But looking at the bigger picture, the health care system already can handle the strain its under, and NO ONE is receiving adequate health services. Not only that but the percentage of obesity is rising, and this is going to put even more strain on the health care system. To make sure that they health care system can function properly and provide adequate levels of care to the public, it must be run like a government; catering to the majority.

 

This doesnt mean we start imprisoning those who are ill or have costly conditions that they never asked for. It means we have to draw the line, and say that it is the responsibility of the public to make sure that they take care of their bodies, and not put them under negative strain. Or else our health care system is going to be even worse off then it is now.

 

It might not be pretty, it might not be nice, but it will lead to lessened strain on the health care system and a healthier population. Why? because yes, people who smoke/whatever don't care about dieing, they see it as something that will happen in the obscure future, but if suddenly, the health care system says that it is taking on a policy of "tough love" it will force these people to abandon any bad habits they have, and take better care of themselves, it will terrify people to think about having to stay at home and be in pain, because they can't afford to get treatment. People fear pain more than people fear death, its irrational but its true.

 

If I honestly believed that there was another way that was for sure to work, and was kinder, then yes I would say we should do that.

 

But look at the problems that they health care system is going to be facing:

 

-already we have a shortage of doctors

-a lack of proper funding means there isnt enough equipment and open hospitals, and they are withdrawing more and more health care services/facilities from small rural areas

- obesity is on the rise, which leads to more hospitalization, more procedures, more costs

-smoking while lower than it has been its not barely decreasing in recent years, this as well leads to more hospitalization, more procedures, more costs

-binge drinking is on the rise in youth, this leads to immediate hospitalization (some cases) and health problems down the road which will lead to more costs

- Not only that but the percentage of the Canadian population that are seniors/retired is increasing and is expected to keep increasing. Elders require more care and usually more procedures than younger people, which leads again to more costs

 

 

and I am sure I am missing a whole load of issues facing the public health care system in Canada, but this just goes to show you that the costs to the public health care are just going to keep rising, and the government won't providing adequate funding that health care will need. Hell the government doesn't provide adequate funding now!

 

Like I said, on an individual basis, I would rather not support what I do, but looking at the big picture, I think it would be the more effective way at keeping the minimum level of healthcare needed in Canada.

 

 

 

 

As for your question on those who speed, and such. These are behaviours that carry risks with them. If you speed you will not always injure yourself. We can't charge people who engage in "risky sexual behaviour" (other than the prostitutes i believe you are referring to swingers) because you don't get an STD everytime you have sex.

 

Smoking isnt these things. If you smoke, you will damage your body. Every time a person inhales a ciggarette they damage their body. Eventually this damage may/may not cause something seriously bad to happen to the person, but they are still damaging their bodies. Same with obesity, if you are overweight/obese, this puts strain on your body. You tend to have more cholesterol, higher blood pressure etc. All this damage may/may not lead to something seriously bad for the body, but it is still damage to the body.

 

 

As for the prostitutes, prostitution is illegal in Canada, so it is a little hard for charging someone for doing something that they legally can not do. Not only that but you would have to prove that they are prostitutes and not just someone who likes to have sex alot with multiple random strangers. Not to mention the fact that if the police could do their jobs better there would be a lack of prostitution or at least less of it.

 

 

 

Either way, I don't think its ethical for everyone to have to pay for the behaviours of a minority. I don't want my children to have to pay extra in taxes,when they become adults because the health of Canadians is even farther in the toilet than it is now.

[Vallinar]

First off while there are some people who truly don't care, most overweight people i know are always on some diet. I am skinny and have no idea what they are going through, and if you have never been obese neither do you. It is believed that there are neurochemical forces at work, genetics play a part, as well as addiction. So to make a blanket statement that obese people are doing nothing for themselves, simply isn't true. Some aren't, some are.

 

There is also the issue of upbringing. Say a child grows up with two obese parents and by the time they are 18 they are morbidly obese, has type 2 diabetesetc. So do they start paying healthcare premiums when they barely stood a chance? Do you force them to drop 200 pounds right away?

 

There is also the issue of proving that their condition came from their behavior. Yes it is common knowledge that all these behaviors are health risks, but you can't say for certain if the behavior caused the disease in some cases. My friends dad died of lung cancer, he had been smoke free for six years when he was diagnosed, he had also been exposed to asbestos and various other effluents in his work place.

 

There are also the practical issues of enforcement. Someone could conceal they are smoking, lie about quitting etc. Are we going to have investigators following these people around seeing if they go to burger king or light up?

 

I am not saying that they shouldn't pay for their choices, I just find it more practical and and ethical to have them pay at the cash register. Junkfood is terrible for everyone, and it effects all of our health, obese or skinny to a point, so shouldn't we all pay a price when we decide to engage in something unhealthy? Seems unfair that a genetically thin person should be able to eat mcdonalds and drink a 2L of coke each day and not pay, but the person who has been fat since they are 5 does. It may also deter people from poisoning their kids with high fructose corn syrup, setting the stage for a lifetime of health issues. Right now it is much cheaper to buy garbage food then healthy, and that is just wrong.

 

 

Well its not just about diet. the overwhelming majority of fat ppl don't put enough effort into both diet and exersise and they are not consistent enough. I think its BS for us to promote the "who cares if ppl think your fat, all that counts is whats in the inside". This just makes fat ppl jsutify their problem and thus not do anything about it. Eitherway i would obviously not advocate making these charges right away. Only after the doctor can assess the patients history, would the doc be able to make such charges. (only those who are obese mostly due to lack of effort and initiative should be charged and not ppl with thyroid/metabolsim problems).

[ccc]

I think I disagree with some of the opinions posted above. In regards to a "fat" tax or some tax on junk food...

 

1) Do you really think the government would do that? Is it realistic that our government starts imposing a penalty on people that eat chips? How do you think Coca-cola or other companies would respond if our government decided that buying pop from vending machines should cost $0.50 more. What about the people that eat junk food and still remain healthy? "Whoops, collateral damage?" I think this suggestion is (very) unrealistic...

 

but if you believe otherwise:

 

2) We do not dictate people's lives. I think most of us value our free will, and by saying that taxes should be placed on items X Y and Z so people can live a healthier life... well to what extent? Are you eventually going to ban foods altogether? Tell people what to eat, how to live their life? No one likes to be told what to do, and putting a tax on it is really just a punch in the face (in my opinion). I think what we can do is encourage healthy eating/lifestyles - think of something innovative to do there. Make healthy foods cheaper. Inform the public of the dangers of over-eating, etc.

[DalNeuron]

people who smoke/whatever don't care about dieing, they see it as something that will happen in the obscure future, but if suddenly, the health care system says that it is taking on a policy of "tough love" it will force these people to abandon any bad habits they have, and take better care of themselves, it will terrify people to think about having to stay at home and be in pain, because they can't afford to get treatment. People fear pain more than people fear death, its irrational but its true.

 

I'm really sorry that you have this view of the people around you... I don't know who exactly you're thinking of when you say that "those people" don't care about dying, but it's no person that I know. Then to go on to say that its okay to terrify the country into submission... into conforming to the 'norm' of an average weight non-smoker... I know some military juntas around the world that would probably agree with you on these tactics, but what a horrible way to live one's life!

Isn't it about encouraging people to be better? Bringing the best out of our fellow man/woman? Aren't these ideals that make more sense? If obesity is crippling our children (and it certainly is) then society has failed at letting parents know the importance of a healthy lifestyle and we need to fix that! (I am encouraged by the commercials playing on tv now with the little kids pretending that they are old: getting hip replacements, brittle bones etc. With the stern warning that our children are aging sooner than normal... this is the kind of intervention we need!!)

 

No no no no no to a fat tax. ccc covered all the pertinent points there, good for you.

 

By the way, did anyone else see the article on CBC about the wait-times?

Basically some researchers did a study of the purely economic impact of having these long wait times (increased time on pain meds before surgery, time off of work while waiting etc...). The numbers were staggering, and offer another type of ammunition to go to the politicians with... It's sad that they need the money aspect for it to matter, but them's the ropes.

Check it out

http://www.cbc.ca/health/story/2008/01/15/waittimes-study.html

[Wolvenstar]

It's not a view of the people around me. it's my view of smokers. What I mean by they don't care about dying is that there is this mentality that "well everyone dies, and I am going to die someday, so it doesn't matter if I smoke or not." and whether others want to believe it or not, this is a common view/saying that I, myself, have heard from many people who smoke/drink/partake of drug use.

 

The thing is that there are attempts to encourage people to get better, but the rate of overweight/obese people in North America are rising. Now we could continue to hope that suddenly everyone will one day wake up and go "Oh! I should start taking better care of my body, and promoting healthy activities to my children." I doubt this is going to happen.

 

Now I don't know about you, but if my grades were failing, or i wasn't doing chores around the house, my parents didn't go; "Oh we just need to discuss with him, why these things are important and he will understand and start doing better." No my parents get me a swift kick in the ass (proverbial, they didn't actually kick me in the ass), and guess what, I have great grades all through school, and now living on my own my house doesn't look like a dump. Tough love works when encouragement fails.

 

Many people tend to not care, or under-estimate the important of a healthy lifestyle. now I do not mean that they go "bah what do I need to be healthy for!" It's more of a being too busy to bother with what society is trying to show them.

 

Now when you were in elementary school, I highly doubt your teacher just ignored it when you didn't complete assignments and said to herself; "I need to speak to my class about the importance of doing one's homework", I am quite sure you were punished in some way, ie; detetion, lines, sitting out in gym, something. Now this seems to work in the elementary school level, why can it not work on a higher level. Sometimes people need to receive the same treatment children do, sounds condescending I know, but its true and it works. Just because someone is 18/25/36 doesn't mean that they are at a level of maturity to be called an adult. Hell I have met kids in highschool who are more mature than some middle-aged people I know.

 

It's societies responsibilities to:

 

1.) encourage healthy lifestyles

2.) make sure that people understand they have a responsibility to themselves and everyone else, to maintain a decent level of healthyness

 

Honestly being healthy shouldn't be a life-style choice! I mean is it legal for someone to start slicing their wrists with a razor-blade or are they forced into some sort of supportive/help group/therapy, because this sort of "lifestyle" is wrong.

 

I know many won't associate suicide and things like alcoholism/smoking/obesity. But these things can be looked at as a form of slow suicide; especially smoking and alcoholism!

 

We, as a society, don't allow people to physically harm themselves, through violent means. So why do we, as a society, allow people to physically harm themselves through non-violent means? It may be less visibly offensive to us, but it still is doing harm to the person.

 

 

Indeed, I am against a fat tax as well, though.

[jmlconkl]

We could create new taxes on "junk" food and everyone who buys some ever would have to pay more for it, even those who are not obese. I say that it is not fair that those who keep their bodies relatively healthy should not have to should the burden imposed by those who smoke/are overweight/alcoholics, etc. Should the general public have to pay extra because a minority of the population decides they want to puff on cancer sticks and end up needed operations for it? If a young male continously goes out to the bar every weekend and overindulges resulting in a trip to the hospital should the public have to pay for his fees too? Is it ethical to have the public pay for the care given to those who couldn't give a damn about their health?

 

I strongly disagree with this line of reasoning. The "junk food" tax idea is no less fair than a tax on cigarettes (which few would argue against). While you may say that "healthy"/non-obese people are unfairly penalized by junk food taxes, the fact is these foods still have negative impact on health even for thin or otherwise healthy people. Will you seriously impair your helath by having a can of pop now and then? Of course not if you maintain an otherwise healthy lifestyle. But the exact same thing could be said of smoking... someone who only rarely smokes and maintains an otherwise healthy lifestyle is not seriously compromising their health. Do they still have to pay tax on their cigarettes, even though they are not consuming them to the point where they are developing health issues? Of course!

 

These taxes are fair because they penalize based on the amount of consumption, and thus someone who consumes massive amounts of junk food (or tobacco) pays appropriate taxes that will benefit them through later healthcare, while those who maintain a healthy lifestyle (minimal junkfood/tobacco) are minimally taxed.

 

At the same time, the junk tax option offers a win/win situation which is not paralleled by the "honeypot" strategy of making healthy foods cheaper. That is, if the tax works, people buy less junk and get healthier. If not, appropriate funds are generated that can go directly to obesity/nutrition related healthcare services.

 

I have yet to see a reasonable argument against this idea.

[kimmiegibbler]

I strongly disagree with this line of reasoning. The "junk food" tax idea is no less fair than a tax on cigarettes (which few would argue against). While you may say that "healthy"/non-obese people are unfairly penalized by junk food taxes, the fact is these foods still have negative impact on health even for thin or otherwise healthy people. Will you seriously impair your helath by having a can of pop now and then? Of course not if you maintain an otherwise healthy lifestyle. But the exact same thing could be said of smoking... someone who only rarely smokes and maintains an otherwise healthy lifestyle is not seriously compromising their health. Do they still have to pay tax on their cigarettes, even though they are not consuming them to the point where they are developing health issues? Of course!

 

These taxes are fair because they penalize based on the amount of consumption, and thus someone who consumes massive amounts of junk food (or tobacco) pays appropriate taxes that will benefit them through later healthcare, while those who maintain a healthy lifestyle (minimal junkfood/tobacco) are minimally taxed.

 

At the same time, the junk tax option offers a win/win situation which is not paralleled by the "honeypot" strategy of making healthy foods cheaper. That is, if the tax works, people buy less junk and get healthier. If not, appropriate funds are generated that can go directly to obesity/nutrition related healthcare services.

 

I have yet to see a reasonable argument against this idea.

 

 

I also don't see the difference between junkfood and alcohol. Both are consumed, not for nutritional reasons, but for pleasure. Junkfood offers about the same nutritional value as beer, a lot is worse.

 

I don't think it is a coincidence that when I was a kid chips and pop were consumed only at birthday parties and during holidays etc, and the child obesity rate is considerably higher now. Obviously there are other factors at work but the fact remains that you can exercise everyday and still be fat, but if you have an appropriate (energy imput=energy output) healthy diet you may not be fit but you won't be fat.

 

I also don't believe the obese or smokers don't give a damn about their health. I think the most morbidly obese are the most terrified and care a lot. At that point its more then just laziness or bad diet that got you there, its a compulsion and addiction. They know its going to kill them. If you think pain is what they will be scared of.......those people are living with chronic musculoskeletal pain already.

 

Our opinions on smokers obese and what they deserve or should pay for really are just that, opinions. There is no wrong or right, it is relative depending whose eyes and ethics are evaluating the situation. I guess that is why policy is so hard to create, nothing is going to make everyone happy.

 

I am going to bring up something i don't think was mentioned for a new point of discussion and that is the fact that cigarettes are legal and the government brings in a ton of tax revenue from them, most of which never reaches health care. If we know that cigarettes kill people, are extremely addictive, and cost the health care system a ton of money why aren't they illegal. Laws are put in place to protect us even if the offenders don't initially like it. People hated the seatbelt law. At one time it was believed that domestic abuse was a family matter.

 

So this leads to another point about making smokers pay for their care. How could it be fair for the government to collect tens of thousands of dollars from a lifelong smoker and then make them pay more when it makes them sick. Its like saying its okay for you to do this when we make money from it but not when it costs us. It screams hypocrisy.

 

Perhaps if smoking was illegal and people were doing it anyways through smuggling etc the logic of making them pay for it when they get sick makes a little more sense to me. I still wouldn't agree with it though;) .