1) On a financial basis, I can't blame a business for reducing risk. When I have a firm fixed price contract to install a satellite ground station, I always do everything I can to minimize risk. Where I can't remediate the risk, I mitigate it through increased price. And if I can't remove risk by remediating the contract or mitigating the risk, then I won't bid on the work. How can I blame a business that specializes in surgery for doing essentially the same thing?
2) Having said that, this is the fundamental problem when you have a third party (either an insurance company or the government) make the contract with the business rather than the party who actually receives the services. The insurance company / government is going to have a primary interest in controlling their costs, thus minimizing the risk that the premiums they receive from the pool of insured people doesn't exceed the money paid out to providers, while the providers seek to minimize the risk that the amount they're paid exceeds their costs to provide the services.
If the individual contracted with the surgeon rather than the insurance company / government making the contract, then they could take all of the individual contingencies into account when doing the contract. And the individual would have a big financial incentive to reduce behaviors that would cost him more in medical expenses (like hip surgery).
They are talking about elective surgery. The party electing to have the surgery is the patient NOT THE DOCTOR who is suffering from the GOD SYNDROME.
If the customer voluntarily enters into the contract, then the insurance company has a secondary interest in engaging in practices that attract customers. This is not an issue with a captive clientele.
Sure, I can see their POV regarding this. If this is the case, how come they say nothing about age, fitness level, drinking, drug use, being overweight, or other risky lifestyle choices? All of those choices are risk factors for complications.
If a doctor warns you that one of the issues noted above will cause problems, listen to them.
On the flip side though, doctors and hospitals won’t guarantee that you will not contract a disease or get an infection from being in their hospital, and will force you to sign a disclaimer attesting to that before you go under the knife.
First, show me where smoking has anything to do with back surgery!! what a crock of bullshit!!
Very good analysis. Thank you for those thoughts.
The main surgical prob w/smoking is that it negatively impacts circulation which is why, in general, it’ll take a smoker longer to heal than a non smoker. If you’ve ever seen those carbon monoxide warning on packs, that’s what causes it. CO tends to pit the inside of arteries and veins. This operates in addition to the obvious lung probs.
Per arguments I’ve seen here: lawsuits can thus be closed by demonstration the smoker had continued to smoke. There are simple blood tests for this.
Per tax dollars, if you haven’t noticed, tobacco is abusively taxed. Smokers not living as long as others also draw fewer tax dollars due to an absence of social security payments. If you’re going to use a tax dollar argument, you could only argue smokers should be treated at no charge since they’ve paid so much all along. In fact, thanks to wellness plans, smokers will pay more for insurance. If insurance is not going to cover it, then smokers should actually pay less.
All surgery has risk. I think most smokers underestimate the threat of complication in their case. Nevertheless, as with all surgery, you only do it if the risk outweighs the benefits.
As a smoker myself with addiction level a 10 on a 1 to 10 scale, I can tell you I consider myself surgery-averse. It’d have to be pretty debilitating for me to even consider it.
Should medical insurance be a mandatory redistribution of wealth? Should healthy people have to pay for the weak?
People have to decide if they want to be poor socialists and live a trace longer at the expense of others, or preserve the right to life, liberty, and the pursuit of happiness, and pay for you own damn doctor.
To address your two points more directly:
1) Financially, smokers are paying more through excise taxes and more expensive insurance, on an individual basis, and draw fewer tax dollars by having shorter lifespans, on a population basis.
2) I would say the fundamental problem is the confusion of population vs individual. As a population, you can certainly say smokers have higher surgical risk. However, at the doctors office, it is the individual who is under consideration, not the population at large. Simply being a smoker is not sufficient because, believe it or not, not all smokers are in the same physical condition. The individual can be tested.
Per contracts, if smokers are going to be excluded from certain coverage then there is no reason to charge them more for the coverage they do get. They should be charged less.
Also per contracts, a fundamental problem is requiring people to have insurance. In a free market, insurance companies could discriminate on coverage and policy holders and the individual can decide whether or not to buy it.
For non smokers contracting with those same insurance companies, they could decide whether or not it is worth it for them to have a policy from a company that handles smokers a certain way.
And a doctor who says “I won’t operate on a Black person, an Oriental person.....” Not to say the Hippocratic oath, which is probably ignored in modern medical schools.
In this case you have an individual who is a high risk for surgery. Take away the insurance companies and I still don't see why the doctor would want to take on the risk of liability on his own. Because of the patient's history of abusing his health, if he dies on the operating table or has complications following surgery then the doctor is still liable to be sued.
And hugely obese patients? How about COPD patient? How about cancer patient? How about alcoholic that may begin DT’s during recovery?
This is silly. Where do you draw the line. Nonsmoker here but nobody is in perfect health and anyone can crash, have complications etc from any surgery, tiny or big.
You sign a permit stating what can happen to you from a particular surgery; read it before you undergo the knife.
While I agree with all you say, I am not against insurers, in any insurance arrangements (whether directly by the individual or as part of an employer/union plan) simply charging a higher premium to a smoker. That would be very much supported by the statistics, and it is statistics that insurance actuaries base their rate-making judgements on, not the individual.
I would think an individual joining an HMO type plan, like a Kaiser plan, could meet the same smokers-rate premium argument.
For the sake of the country, perhaps they should refuse to operate on liberals.
Starve a liberal, feed a free country.
Let a doctor refuse to operate on a gay patient with HIV, and see what happens.
Short thought - they are nazis.