How would you replace/fix ObamaCare?

[bedstuy]

The way to resist the effect of obesity on healthcosts is to attack its root causes: the overuse of sugar, the promotion of shoddy advice, the lack of time for people in poverty to prepare food for their families etc. Overwraught and moralistic plans (but what if their was a fat tax?) have no real effect at the end of the day, beyond making people feel superior.

Sure, we can go down the 'attack teh FATTIES lol!!!!' route, but it is rather stupid at the end of the day. First it boosts the craven and idiotic ideology of 'fat=unhealthy, skinny=healthy' (which is largely a construct of the insurance industry, rather than medical science). I, for example, have exactly 'correct' BMI but I have no doubt that a lot of people who cross the threshold of BMI are very much healthier than me.

It is very much more efficient to treat people the same, however much you feel they 'did this to themselves'.

I'm inclined to agree.  But, you're wrong on the medical issue of obesity.  1.  Obesity is not strictly BMI, because BMI does not account for body composition.  2.  Having a lot of body fat is never healthy.    It's not fatal, but being 30% body fat or more isn't healthy.  3.  The fact that obesity is not the only factor in overall health is a banal fact.  You can be a healthy heroin addict who uses dirty needles, doesn't make as healthy as not being a heroin addict who uses dirty needles.

That said, it seems fairly pointless to turn insurance into this punishment/reward system.  It would ultimately punish sick people and unfairly reward people with a few positive data points on their medical chart.  And, would it really be worth it, the cost of gathering all that data might just outweigh the benefit.

Instead, we ought to look at how we incentivize diet and lifestyle through our government policy.  Just think about the fact that we have huge corn and wheat subsidy programs, when those products in the form of processed foods are leading to obesity.

[bedstuy]

The way to resist the effect of obesity on healthcosts is to attack its root causes: the overuse of sugar, the promotion of shoddy advice, the lack of time for people in poverty to prepare food for their families etc. Overwraught and moralistic plans (but what if their was a fat tax?) have no real effect at the end of the day, beyond making people feel superior.

Sure, we can go down the 'attack teh FATTIES lol!!!!' route, but it is rather stupid at the end of the day. First it boosts the craven and idiotic ideology of 'fat=unhealthy, skinny=healthy' (which is largely a construct of the insurance industry, rather than medical science). I, for example, have exactly 'correct' BMI but I have no doubt that a lot of people who cross the threshold of BMI are very much healthier than me.

It is very much more efficient to treat people the same, however much you feel they 'did this to themselves'.

It isn't more efficient to treat everyone the same, anymore than it's more efficient for a store to sell all of its goods for the same price. If you are going to be incurring more costs to the insurer/medical system, it makes sense for you to pay more into the pool/system.

Not necessarily.  This is one of those libertarian teenager fantasies, that everyone gets what they deserve.  Fat people get sick, skinny people don't.  That's not true.  Some thin people are going to get leukemia or crohn's disease or break their pevlis in a car crash.  There's often no rhyme or reason to it.  And, there's nothing that person could have done to avoid that outcome.

I think if someone has a childhood cancer, that shouldn't permanently disqualify them from private health insurance like it did before Obamacare.  If someone has a chronic illness, that shouldn't bankrupt them or keep them paying $4000 a month just to stay alive.  Being a decent society means that we take care of people who get sick and help chip in to pay for them.  And, if you're paying a higher premium without ever taking advantage of your coverage, you're lucky.  Being healthy is immeasurably more important than saving $60 a month in health insurance premiums. 

However, you are right to think about how we incentivize people towards a healthy lifestyle.  But, insurance seems like a bad way to create those incentives.  We ought to look at farm subsidies, city planning, and a number of other things first.

[bedstuy]

Here's my take. 

If charging someone more causes them to change their behavior in a way that reduces costs, it's something to consider.  Like with smoking, smokers pay a cost for the habit which hopefully covers some of the negative externality that they create.  Although for other health data points, you have to consider whether collecting all the data is worth the effort or actually fair.  For example, it's wouldn't be fair to judge whether someone is fat based on their weight or their BMI.  What if someone has an athletic frame and a lot of lean muscle, should they pay more for the health insurance?  I don't think so.  So, does everyone in America get an annual body fat composition test?  It could be way more trouble and administrative cost than its worth.

But, it doesn't really do any good to charge someone who had cancer 10 years ago more, even though they're a higher insurance risk.  I don't care how much you incentivize someone, they can't just force themselves to not be a cancer survivor. 

You need to think about what health insurance is.  It's not an optional thing like car insurance or personal liability insurance.  Someone can say, hey, I can't pay xyz rate, I better get a cheaper car or I better not operate a skydiving business because I can't afford the liability insurance, or I better not build a house on that 2 year flood plain.  That doesn't work with your health.  It would be nice if you paid, hmmm, I can't afford colon cancer, I better opt for a head cold.  But, it doesn't work that way.  Health insurance covers the costs of being alive and being alive is not an optional thing, in fact, it's mandatory at least for alive people.