One year ago in these pages, Harvard Medical School’s Stephen Soumerai wrote a scathing essay arguing that employer fines on overweight employees were ineffective. We’re here to tell you that Professor Soumerai is a cockeyed optimist. A new review in the American Journal of Managed Care shows that these fines transcend ineffectiveness. They are counterproductive.
To begin with, forced corporate weight loss programs don’t work. Of roughly 1000 wellness vendors promising weight loss, only one, the iDiet, has received validation. Literally no other corporate weight loss program can check three simple boxes that are standard in medical research:
- The study was controlled the way grownups would define “controlled,” not using unmotivated non-participants as a control for motivated participants, which Health Fitness Corporation inadvertently invalidated
- the program was sustained for 18 months, rather than eight weeks, which seems to be the new standard for get-thin-quick programs; and
- The results showed both high persistence and significant weight loss.
Even that study had significant limitations: One could argue that the sample was small and even 18 months was not a long enough period to determine if weight maintenance was likely to be permanent.
As compared to the 1-in-1000 vendors with legitimate study designs and results, we’ve outed thirty programs, like ShapeUp’s, that simply make up weight-loss outcomes. Usually (as in ShapeUp’s case), data manipulation takes the form of reporting “last man standing” outcomes ignoring dropouts and non-participants, which in ShapeUp’s case comprised the vast majority of all eligible employees. Shape-Up went a step farther, and failed to report on people who had gained weight over the period. (Their report, on their “success” at Highmark, has disappeared from their website.)
Let us assume, for a minute, that these programs could help people lose weight and sustain the weight loss. What would the impact be of that weight loss on healthcare costs and productivity? Looking at healthcare costs two totally different ways yields the same results. Government data attributes 3% of healthcare spending to increased obesity. A company that succeeds in reducing that by 10% would save 0.3% of all health spending.
As an alternative methodology, use wellness-sensitive medical events. They account for about 4% of spending. Reducing that by 10% would save 0.4% of all healthcare spending. Even if these numbers are off by a factor of 10, the net impact would still be a trivial reduction in total corporate expenses.
Nor is there any savings in productivity. Fatter people don’t type, talk, present, drive, teach, write, add, cross-examine, subtract, paint, prescribe, assemble, or do anything else (except maybe deliver packages or steal bases) more slowly than thin people—which is why fatter states and countries enjoy economic growth equal to or greater than their thinner counterparts.
Once again, even if we’re wrong and there is a trivial positive impact on productivity, it couldn’t approach the program expense and especially the morale impact of shaming, demoralizing and invading the privacy of employees. Employees hate these programs, which is why fines are needed to force participation. Even so, occasionally they revolt (like Penn State and CVS) or sue (Honeywell).
So far, our conclusions agree with Professor Soumerai’s. But as mentioned above, we go a step farther and put these programs in the realm of “counterproductive,” not just ineffective.
Attaching money to weight loss would naturally lead to bingeing before the first weigh-in, followed by crash-dieting before the last one. Perhaps even more importantly, a growing body of literature supports that repeatedly losing and gaining weight is not benign. (see footnote below) In fact, it may actually worsen many of the conditions that losing weight is supposed to cure. Even companies that make their money off weight cycling don’t endorse it.
Beyond that, some programs, notably Aetna’s, can specifically harm employees in the name of wellness. Aetna has partnered with a couple of unsuccessful drug companies to pitch obesity drugs to obese employees, drugs whose hazards prompted an editorial in JAMA Internal Medicine arguing that they never should have been approved. (One of these drugs is Belviq, which has the 3rd highest ratio of physician payments to sales of any drug.) Aetna has failed to disclose this editorial, and declined to answer questions about their program, including how can they position these drugs as “increasing productivity” when the drug’s disclosed side effects include impaired memory, attention, and language.
A great question is, why? Why would employers undertake programs that demonstrably fail, damage morale, and even sometimes harm employees? While stupidity and dishonesty can never be ruled out in situations in which benefits consultants are the major source of advice, there appears to be another more insidious motive: these fines themselves are now major sources of savings, as Bravo Wellness says on its website.
There is some good news. Companies that don’t obsess with their employees’ weights enjoy a significant competitive advantage in recruitment and retention simply by spending time maximizing the value of their endeavors rather than humiliating employees with weight concerns. So speaking as three people who all run small enterprises, we encourage our competitors to interfere as much as possible with their employees’ personal lives. Since it’s bad for their businesses, it’s really good for ours.
Footnote
Ref – D.M. Bhammer and G.A. Gaesser. “Health Risks Associated with Weight Cycling.” In Wellness, Not Weight: Health at Eery Size and Motivational Interviewing. Ed. Ellen R. Glovsky. San Diego: Cognella, 2014.
Al Lewis and Vik Khanna are co-authors of Surviving Workplace Wellness with Your Dignity, Finances, and Major Organs Intact. Their website, They Said What, regales readers with stories of wellness innumeracy and deception.
Dr. Jon Robison is co-founder of Salveo Partners and co-author of the newly released, How To Build A Thriving Culture at Work: Featuring The 7 Points of Transformation.
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Blood Glucose Monitoring
Leo:
You should run a company!
“Which was the point I made in the first post.”
Much ado about nothing.
You were hit by the Arrow of asymmetry and left with empty short quips.
“but from what we know today we would be better off not obligating Paul to pay for Peter’s foolishness.”
From a utilitarian perspective, were I to be honest, I’d have to agree with you.
Utilitarian is a long run metric. Policy is not made with the long run in mind. You can argue that it should be. But it’s not.
Nor is policy made with the “greatest good for the greatest many” in mind.
Which means that the costs of internalizing Peter’s costs to Peter, in the short run, is less than the benefits of those costs being internalized, in the short run.
Which was the point I made in the first post.
I was never arguing against the moral force of your argument, but its practical implementation.
I think we are done with this topic.
“What might those transaction costs be which might determine the worth it factor of trying to internalize Peter’s costs to Peter?”
Too many factors to consider, but from what we know today we would be better off not obligating Paul to pay for Peter’s foolishness. Of course you are waiting to spring your plan on us that I believe some of us have known (the generalized nature) from the onset. I can tell you now if it involves coercion, which it probably does, or involves us obligating Paul to pay for Peter’s detached retina even in a diffused contractual fashion then we will not agree. This lack of agreement has been obvious since post #1 out of 64 so to play the type of game you are playing is quite juvenile. I have to deal with children of all ages so I am used to it.
“Might you be suggesting that the transaction costs of internalizing Peter’s costs to Peter might not be worth it?”
“It depends.”
Phew! ‘Depends’ is concordant with ‘might.’ For a moment I thought I lost you again.
What might those transaction costs be which might determine the worth it factor of trying to internalize Peter’s costs to Peter?
PS 1: note my use of ‘might’ twice. I’m giving you considerable latitude.
PS 2: you are tantalizingly close to epiphany. Hang in there chum!
Saurabh, jab away all you want, my synapses are all intact, but need some stimulation even the low level stimulation you have been providing. You can even be impolite.
I adjust my replies to reflect the tone of the one on the other side. I am still waiting for that truth of yours that will clear up all the issues, end climate change, defeat ISIL and clean up all the toxic waste dumps. You inform me that “But you have given me an anchor. Hallelujah!”. Finally a bit of light is coming into your darkness so you ask:
“Might you be suggesting that the transaction costs of internalizing Peter’s costs to Peter might not be worth it?”
It depends.
NEGATIVE CLANK by Richard Brautigan
He’d sell a rat’s asshole to a blind man for a wedding ring.
Get it fellows?
Probably best for me not to jab your thin skin. As it seems to blunt your synapses.
But you have given me an anchor. Hallelujah!
“I can’t and I might not want to because the unintended consequences of doing so might be worse than the consequences of doing nothing.”
Might you be suggesting that the transaction costs of internalizing Peter’s costs to Peter might not be worth it?
“One day you will learn that not all Neighborhood effects are the same and need be treated identically.”
I love nuance. Enlighten me, old chap.
Saurabh, what you call satire is merely your methodology of altering what other’s have said. Stop the not so hidden insults and get on with the discussion.Your former bright lights are dimming as is your prose. Presently your responses are like the graffiti seen in a public bathroom.
—
“How will you prevent Peter’s cost from diffusing to Paul?”
This was answered multiple times. I can’t and I might not want to because the unintended consequences of doing so might be worse than the consequences of doing nothing.
“(I am rather enjoying this, as I am enduring a boring conference, so thanks for the distraction)”
I have to say Saurabh that your replies are quite dull. But, they are like the soap opera on TV. One can’t put it down because they are waiting for some enlightenment that never comes. I note you have’t walked out of your conference. Based upon your recent postings It sounds like you left your seat and walked into the bathroom.
—
“This is the neighbourhood effect.”
One day you will learn that not all Neighborhood effects are the same and need be treated identically. Until you learn that I guess we will have to live with the dull non productive thoughts we have been reading.
“One can’t permit an Ebola patient to roam the streets and expect no one else to become infected.”
Indeed.
You are finally seeing the light. This is the neighbourhood effect. But I won’t tax you too much by asking you to apply the same principles to one’s choices and the healthcare consequences of those choices.
“I won’t obligate Paul to pay for Peter’s foolishness. That is different than Paul being excluded from payment.”
How will you prevent Peter’s cost from diffusing to Paul?
This is my question. You still haven’t answered it.
(I am rather enjoying this, as I am enduring a boring conference, so thanks for the distraction)
Before you luxuriate in too much schadenfreude regarding the state of our businesses, you might want to check to make sure your internet connection is working.
I’m just sayin’…
“Am I now supposed to prove to you that what you are saying is pure garbage because you can’t defend yourself on the real issues? When did you stop beating your wife? ”
Good lord. This the smartest statement I have read on this blog from you allan!
“You should be careful because some might accuse you of lying”
Oh dear! The satirically-challenged allan, devoid of an atom of irony, is offering me advice.
allan, I honestly believe reports of your cerebral inertia are slightly exaggerated but I should advise you that your pretending to be acephalic is a poor arguing technique.
“There is no C or D?”
Enlighten me.
“Even b) suggests failings of the authors understanding of the subject at hand.”
Enlighten me.
“a) is wrong. Everyone paying out of pocket doesn’t mean treatment and sometimes treatment is a necessity no matter who pays.
Except (a) is conditionally independent of the necessity of treatment. This is what is called a strawman argument.
Here is a little test for allan.
allan, if someone says you are spewing crap that is:
a) Strawman argument
b) Metaphor
c) Misrepresentation of crap
d) Lies about crap
e) All of the above.
Paul, we most certainly were exploring core principles, but Saurabh has this tendency to alter the direction of the discussion and even the questions involved. I too remain interested in his thoughts re the role of lawyers and contracts since much of what I believe in involves well designed contracts that exclude excessive lawyering. So far it is like pulling teeth.
It is preferable to explore core principles before adding the complexities of our present laws.
“In other words Peter and Paul are so separate that Peter’s actions are limited to Peter.”
Must the actions be so separate? Must every action have a reaction?
“It is for this scenario that I have repeatedly been asking allan how will he stop Peter’s costs from diffusing to Paul. He is adamant that he won’t make Paul pay.”
Saurabh you keep saying the same thing though you have been corrected before. I won’t obligate Paul to pay for Peter’s foolishness. That is different than Paul being excluded from payment. I demonstrated this before when Peter’s foolishness injured Paul and thus Paul paid in many ways. (see several responses above) I suggest you refer to a dictionary and research the word ‘obligate’ and the phrase ‘I won’t obligate’. The word and phrase have nothing to do with what happens to those costs. There is a type of butterfly effect that better explains what you have been unable to state in a clear concise manner.
“Do nothing only works when:
a) everyone is paying out of pocket for medical care, That is no insurance.
b) no one is forced to treat Peter for free.”
There is no C or D? There are a lot of problems entailed in this statement Saurabh makes in response to Paul. What does the word ‘works’ mean? If it works 99% of the time does that mean it works or doesn’t work?
a) is wrong. Everyone paying out of pocket doesn’t mean treatment and sometimes treatment is a necessity no matter who pays. One can’t permit an Ebola patient to roam the streets and expect no one else to become infected.
Even b) suggests failings of the authors understanding of the subject at hand.
There are too many distortions and logical fallacies in Saurabh’s arguments.
“JHC! Do you not know the difference between a strawman argument and an allegory, metaphor and simile???!”
Am I now supposed to prove to you that what you are saying is pure garbage because you can’t defend yourself on the real issues? When did you stop beating your wife?
Saurabh, you continue to create a false dialogue pretending to paraphrase my words because you could find no such quotes. You should be careful because some might accuse you of lying. I think you believe too hard in your own words to actually understand what another is saying.
In the future quote my words and don’t paraphrase. Keep quotes in context and stop changing the premise.
Saurabh,
I did not realize you were taking Peter’s problem as one in the current system….thought we were exploring core principles.
Since we are in a curent situation that includes forced free tx, you are right. But there are some simple reforms that would minimize Peter’s temptation to socialize the costs of his behavior. These include Dr. Ben Carson’s proposal for everyone to have a Health Savings Account (for the poor, it would be contributed by taxpayers)…..which means people are more careful in their behavior and in their consumption of medical services…..this is because the funds in the HSA are their own.
You are right this does not eliminate the exportation of Peter’s costs….but it creates an incentive for the Peter’s of this world to not do it.
I remain interested in your thoughts re the role of lawyers and contracts.
“Not every action requires a reaction.”
In other words Peter and Paul are so separate that Peter’s actions are limited to Peter.
This brings us to the same question. How will you achieve and enforce this separation?
Or, how will you stop Peter’s costs from diffusing to Paul?
“(Another straw man argument “ I ask ‘how will you achieve a goal?’ You answer ‘I will achieve the goal.’ ” What above indicates that we have the same goals? In this case nothing need be done.)”
JHC! Do you not know the difference between a strawman argument and an allegory, metaphor and simile???! Sorry allan, I can only instruct you on one topic at a time, so I’m going to have to pass on this one.
“Peter then has to decide…..he may live with his one bad eye, he may pay to have it fixed, he may seek charity care….or he can sue the bungee cord maker.’
Do nothing only works when:
a) everyone is paying out of pocket for medical care, That is no insurance.
b) no one is forced to treat Peter for free.
But if the above conditions are not met Peter’s costs will diffuse to the Pauls. Because the place that is forced to treat for free will raise the price for Pauls. So Peter’s costs will diffuse to Paul.
But let’s say that no one is forced to treat Peter for free, and Peter can’t afford the treatment, so the hospital writes it off. Now again the hospital will raise the prices for Pauls and Peter’s costs will diffuse.
But our situation is more complex because there is insurance and Peter may have insurance as may Paul.
It is for this scenario that I have repeatedly been asking allan how will he stop Peter’s costs from diffusing to Paul. He is adamant that he won’t make Paul pay.
How?
You have become repetitious so for simplicity sake I will copy the previous answer to your ‘How?’hoping to spur you to provide your long awaited answer.
“How will you isolate Peter’s costs to Peter?”
In the interest of moving this discussion along let me help you out here. I don’t have to isolate Peter’s costs to Peter just as I don’t have to obligate Paul to pay for Peter’s foolishness. Not every action requires a reaction.
(Another straw man argument “ I ask ‘how will you achieve a goal?’ You answer ‘I will achieve the goal.’ ” What above indicates that we have the same goals? In this case nothing need be done.)
Saurabh,
I may be blissfully simple minded, but it seems simple in this case: allan and paul simply do nothing. Voila! Other cases will bring in more murkiness and may lead to a discussion of societal obligations to the disabled or poor….but lets defer that to get to Peter’s case as that will help establish principles.
Peter then has to decide…..he may live with his one bad eye, he may pay to have it fixed, he may seek charity care….or he can sue the bungee cord maker.
One might argue that the law suit costs are socialized….but this really is pretty much a one time cost….as once case law is settled the lawyers will no longer take on any similar cases.
It seems you see contracts as part of the answer. Please explain: contracts between which parties and saying what? I will wait for your answer in the allan/saurabh dialogue, but would prefer to hear your analysis right off.
” don’t have to isolate Peter’s costs to Peter just as I don’t have to obligate Paul to pay for Peter’s foolishness.”
How?
Come on. Tell me how will you obligate Peter to pay for his retinal detachment so that his costs don’t diffuse to Paul(s)? I challenge you to answer this question.
I ask ‘how will you achieve a goal?’ You answer ‘I will achieve the goal.’
Think a little, old chap. Think. How do you make someone pay for their meal in a restaurant? How and why is healthcare different?
“For a person that doesn’t “give a flying rat’s tail about your ideology” you sure do ask a lot of questions about it.”
It’s called curiosity. You should try it as well. It does wonders.
(I did promise you I was not going to give up on you on this one. I’m keeping my promise!).
The all knowing one has once again repeated himself, CONTRACT “It’s called a contract” but then runs and hides. No substance to anything said in your dozen or so replies. This is a superiority complex that has gone amuck.
In human interaction there is no such thing as total isolation from costs or anything else. That is something even a simpleton might understand, but you seem to make a big thing out of it “you and your costs should be separate from me and my costs, is practically unenforceable” You have been lecturing us on this subject without end and without enlightenment. You have had nothing to say.
You do try to elevate your status by talking about how you lead others by the finger as if you are some master of a 19th century plantation. Well jeez boss I donna need you to teach me about life and teach me how to pick cotton through that there Socrates method. I’m the one picking it and you don know what cotton look like.
For a person that doesn’t “give a flying rat’s tail about your ideology” you sure do ask a lot of questions about it.
“But you do have the advantage of being oblivious to irony, and I must say that I envy that bliss.”
This I understand. I’m not oblivious to irony. You sometimes have a problem communicating and irony is a form of communication.
“How will you isolate Peter’s costs to Peter?”
In the interest of moving this discussion along let me help you out here. I don’t have to isolate Peter’s costs to Peter just as I don’t have to obligate Paul to pay for Peter’s foolishness. Not every action requires a reaction.
“Tell us the answers. Are you afraid?”
Yes, I am afraid. I am afraid that extreme fairness in healthcare, which takes many forms such as you and your costs should be separate from me and my costs, is practically unenforceable, and if one tries to enforce it, it will be a nightmare of contracts.
You asked how. It was pretty clearly spelled out. Nevertheless.
I walked you slowly through it, holding your finger – metaphorically that is, before you get yourself in to a righteous spasm of literal logic.
And here you stand, essentially agreeing with me, still struggling with the basic question – how will you isolate Peter’s costs to Peter? So badly have you struggled with the question that far from answering it you pretend that the question itself is invalid.
I couldn’t give a flying rat’s tail about your ideology – all extreme ideologies converge in a heap of contradiction, and are indistinguishable. You seem paranoid about socialists, which in the context of healthcare is ironic, and mildly amusing.
But you do have the advantage of being oblivious to irony, and I must say that I envy that bliss.
So go back to the drawing board and think again. It will come up again. How will you isolate Peter’s costs to Peter?
Psst, it’s called a contract.
“ it’s about contracts.”
Time to get on with it and quit stalling. I’ve answered your questions over and over. It is time for you to blow us out of the water. Tell us the answers. Are you afraid?
Comrade McCarthy? I assume you are talking about Senator McCarthy. You might not like him, you might not agree with everything he did, but the one thing that was true and proven about McCarthy was that he was right.
“What would be the mechanism to toll Peter fairly in your libertarian (pie in the sky) paradise?”
What makes you think I am libertarian? Don’t bother answering the question because at one time you asked if I was an Objectivist. I don’t think you recognize that people don’t fit into the slots you allocate for them. Suffice it to say that libertarians have a broad spectrum of political philosophies. Thus before classifying one as a libertarian a definition of terms is in order.
Now you can get back to the job of telling us about your “enforceable contract” so we can stop the games and get on with the discussion.
Here is another one for you to ponder about.
Peter eats fatty food, doesn’t exercise and has a family history of heart disease.
Paul eats broccoli and runs.
Peter has chronic heart failure, ICD and needs multiple medication.
Paul does not strain the healthcare with costs.
How will you make sure that Peter’s costs are not diffused to Paul? How will you make sure Peter is financially punished for his choices? Will you make allowance for Peter’s bad genes? How about the fact that he knew about his bad genes and still didn’t exercise?
What would be the mechanism to toll Peter fairly in your libertarian (pie in the sky) paradise?
“State your case”
How will you ensure that Peter’s costs are not diffused to Paul?
(…..for the hundredth time, in plain English)
Let me try an experiment.
Allan, what are the colours of traffic lights?
(now if you understand this question you should be able to understand the first one. If not, I think you are deliberately obfuscating Comrade McCarthy!)
Very easily, openly and with very few words I explained my boundaries. Then I encouraged you to do the same and fulfill that which you had promised. Get on with it Saurabh and provide us with the contract you wish agreement upon “so that we can move to the next part of the argument”
Instead of doing so you played more games. You asked me to engage in a foolish guessing game and warned me not to include the following argument that adds nothing to the discussion.
“ Peter should pay for the costs because that’s the right thing to do,” Zzzz
Things seem not to be going all that well on your side of the railroad tracks. You were waiting to blow us out of the water with your argument that appears to include an “enforceable contract” and instead you find it a dud. That is what happens when you wait too long.
State your case and stop with the games. Your game is over. Now tell us what it is you wanted to say in the first place.
Saurahb, suddenly you are adding a bunch of qualifiers not present in your prior questioning and you continue to stretch your boundaries. I have already provided you with my boundaries. I have not stated that any or all of the costs must be retained by Peter, rather I have provided my boundary which is I will not obligate Paul to pay for Peter’s foolishness. That the possibility Paul might pay for Peter’s foolishness exists. Think. What would happen if Peter, the speeder, caused an accident injuring Paul. Paul would be paying for Peter’s speeding habits that caused the two of them to collide.
Get on with it Saurabh and provide us with the contract you wish agreement upon “so that we can move to the next part of the argument”
“but the fact that he truly believes his questions can lead to a singular answer”
allan, I’m happy for you to give me a range of answers, just so that it doesn’t include this one:
Peter should pay for the costs because that’s the right thing to do,
Tell me, how will the market sort this one out. I’m all (frustrated) ears!
Paul you hit the nail on the head. I think we all know where Saurabh’s contract leads even if there is a variation to what you have stated. It is not the Socratic method that I find lacking in Saurabh’s commentary, but the fact that he truly believes his questions can lead to a singular answer, his answer when in fact there were many good pathways that could have been followed. His method would have been acceptable if it was only part of a pursuit, but his frustration got the better of him and he closed his usually open mind.
Now I am ready to deal with Saurabh’s contract.
“Is that the point Saurabh?”
Paul, I’m simply asking allan how he will isolate Peter’s costs to Peter.
He said Paul should not have to pay for Peter’s choices.
Fair enough.
It begs the question how Peter will pay for the consequences of his choices.
This is not an argument over whether Paul(s) should pick up the tab for Peter.
I want to know how society will isolate healthcare costs to the individual that result from their choices.
The question is simple. The answer is, admittedly, tough,
“You are trying to impart your ideology into the discussion and I won’t let you.”
How utterly absurd!
How is my asking you a question imposing an ideology? And what ideology might that be Allan McCarthy?!
Of course, it’s about contracts. If healthcare is going to be covered by insurance, and not our of pocket, and you don’t want costs to diffuse, i.e. you want to isolate the costs that are consequent to Peter’s choices to Peter, you’ll need a contract.
I gave you an easy example.
How about the teenager who dislocates his ankle while running fast downhill. How would you prevent Paul(s), who don’t run fast downhill, from internalizing the costs?
You may take the fifth, but the rain won’t stop if you refuse to answer what you’ll do if it rains.
I suspect Saurabh must be thinking that Peter’s detached revenue limits his ability to contribute to society and that it is intolerable if it doesn’t get fixed….and that if we don’t compel Paul to pay for Peter then we must compel Peter to pay for himself…..I guess through a forced contract with legal penalties if Peter ignores his obligations.
Is that the point Saurabh?
I’ve been following this, but I don’t think the Socratic method plays well in a blog/comments section….respectfully, I suggest it would be best just to lay out one’s line of thinking.
“Can we agree on contract so that we can move to the next part of the argument?”
No. Other than a contract between a willing buyer and willing seller the answer is no. My arguments are both philosophical and economic. You are trying to impart your ideology into the discussion and I won’t let you. That has frustrated you enough that you have become a bit condescending which is fine, but also a little insulting which is not. Your question to the present has been limited to “How will you make sure that Peter pays for the detached retina from bungee jumping?”
No one but Peter need pay for that detached retina at all. Since your question doesn’t include moral issues society need not even think about it.
I don’t have to play your games and jump through your hoops to answer an unasked question that only muddies the water even though I know from experience where you are coming from. I try and keep things clean and above board. If you have the bad taste to play these games do it with your Interns, not with me. …And by the way you haven’t answered my question which I feel is just as relevant to this issue.
“What I have been repeatedly asking you is how would you isolate Peter’s costs to Peter.”
That has been repeatedly asked and answered though this new question is phrased an a way that broadens the issue beyond the simple repair of a detached retina.
“What makes you think it is anyone’s obligation to pay for Peter’s stupidity?”
This is amazing. I no longer believe that you are deliberately obfuscating – my apologies for doubting you. You really don’t get the issue. There is an impasse here. You really don’t understand the question.
That no one but Peter should pay for Peter’s stupidity is a moral issue. The question I’m asking is not whether this moral issue is right or wrong. What I am asking is how will society enforce that Peter pays for his stupidity and that those costs don’t diffuse to anyone else?
There is an answer here. A simple answer. It’s called contract. Not social contract. No one need follow a social contract if they don’t want to. But an enforceable written contract.
Can we agree on the need for an enforceable contract? This has nothing to do with whether Paul should or should not pay for Peter. This has to do with how one ensures Peter pays for his detached retina from bungee jumping.
What you have been doing is giving me whole lot of arguments why it is morally wrong and unfair for Paul to pay for the health consequences of Peter’s indulgences.
What I have been repeatedly asking you is how would you isolate Peter’s costs to Peter.
Can we agree on contract so that we can move to the next part of the argument?
“I will give you one more chance and then tease you with a possible answer.”
You are asking how *I* would make sure that Peter pays for the detached retina. Saurabh, that means you are looking for my answer, not your own, so you can’t tease me with a possible answer because the chances are that I know that answer, but I do not believe in creating new obligations for others especially since they have obligations of their own.
I wrote “Of course I answered your question.” to which you curtly responded “No you haven’t. You have digressed in to a ramble”. The only ramble I have seen is your rhetoric absent substance though with a few big words and good prose. You are a good writer, but sometimes content is more important and reading what another says is doubly important.
Are you going to tell me the prior response (following in quotes) doesn’t answer the question you posed??? [“But you have not answered how.”]
“Answer to how: Paul will not pay. If Paul doesn’t pay Peter the bungee jumper will live with a detached retina or find another way to have the retina repaired.”
I’ll expand the answer to “how” so you can see how these things work. Maybe Peter the bungee jumper wasn’t as stupid and didn’t require so much paternalism directed his way. He might be carrying insurance or he might have earned enough money that it was available to pay for his detached retina. Peter could have had a Porche or home so I wonder how Peter paid for the Porche. Hmmm. Can anyone think of a way? Yes, he can do what most Americans do and take out a loan or place a second mortgage on his house.
“How will you make sure that Peter pays for the detached retina from bungee jumping?”
Read the words above again. What makes you think it is anyone’s obligation to pay for Peter’s stupidity? We could of course ban bungee jumping and any activity that causes harm. Bye bye ski vacations. That type of action is what some very paternalistic folk advocate. That would save more attorney costs than anything else you suggested. Personal injury attorneys who generally side with paternalistic leftists would fight against that however, not because they like to ski, but they sometimes they depend upon the stupidity of the Peter’s of the world hoping the deep pocket Paul’s will make them rich.
Now you can reciprocate by answering my question:
“A) Too bad Paul you shouldn’t have loaned him the money. or
B) Paul wins his case. Paul didn’t rape that 14 year old girl so why should he pay for Peter’s bail? The penalty was against Peter not Paul.
Saurabh, you can chose either A or B. There may be a C and even a D, but of the two choices A or B which is the better choice?”
“Of course I answered your question.”
No you haven’t. You have digressed in to a ramble.
How will you make sure that Peter pays for the detached retina from bungee jumping? Let’s stick to this case.
I will give you one more chance and then tease you with a possible answer.
Mitch
You need to tell the CBO.
Brad
Brad:
Obesity in and of itself is not unhealthy-it is just excess adipose tissue, stored energy. The more insidious problem is the underlying metabolic condition that drives it, which also drives stroke, heart disease, arthritis and on and on-diseases of inflamation. This is THE issue for the sick care system. If you read the dietary advice is nearly every wellness vendor you’ll find it is based on the standard, wrong government advice that got us to this place. I knew twenty years ago (through my own research and a wonderful physician) that cholesterol was a bogeyman and fat was not only not bad for you, it is healthly if not from a CAFO animal. There is a reason hunter-gatherers eat the organs first, then the fat, and give the muscle to the dogs.
I could go on but you get the idea.
Of course I answer