About 80% of obese people with sleep apnea would be asymptomatic if they reduced to a non-obese weight. For this subset of people, shouldn't insurers (and often the Public) encourage the patient to use the free, safe, and natural solution (eating less) before being dependent on an expensive machine?
On a practical level you need to accept that most people trying to loose weight fail, succeeding will still take years to lose the weight, and that most of those people will suffer significant medical problems from sleep apnea in the mean time.
> About 80% of obese people with sleep apnea would be asymptomatic if they reduced to a non-obese weight.
Where are you getting this from? I didn't see anything like it in the study you linked, it doesn't match the general impression I've gotten reading other OSA studies, and it's unusual for lifestyle intervention studies to have a large number of people lose enough weight to go from obese to non-obese. Are you sure that you're not neglecting some other qualification of the population (e.g. mild sleep apnea, bariatric surgery)?
> For this subset of people, shouldn't insurers (and often the Public) encourage the patient to use the free, safe, and natural solution (eating less) before being dependent on an expensive machine?
No, because weight loss takes time, and there's nothing particularly safe about leaving OSA untreated in the interim. Weight loss is a fine thing to pursue for overweight and obese OSA patients, but deciding up-front to do that instead of CPAP is reckless. I agree with the authors of the study you linked when they conclude that "it is clear that treatment of OSA cannot be limited to any single strategy, but rather requires a multidisciplinary approach". Not every patient will respond to or tolerate every treatment approach, and the possibility of synergistic effects should not be ignored.
People have an allergic reaction to the idea that insurance for someone obese should cost more than to someone thats not obese, even though that is actuarially correct.
I feel like there is an obvious reductio ad absurdam. If you are obese, yes, you can expect higher costs. If you are diagnosed with cancer, you can expect higher costs. If you are on your way to an appointment to check for cancer, you are higher risk than someone who has no cause to worry. If we take the idea of discriminating against known risk to an extreme, there would never be a payout at all, because hours, minutes, seconds, or milliseconds before a claim, there is always an indication of elevated risk. If you have full telemetry from all the cars you provide collision insurance for, you can determine that someone is an unacceptable risk moments before impact. "High frequency insurance underwriting" would only be a difference in degree from the sort of discrimination people defend, but it would make the entire industry pointless.
Therefore, I believe that everybody agrees discrimination against known risks must be limited by regulation or other means to make insurance viable; we're just arguing about where to set the boundary. It is generally accepted that race, religion, and so on are prohibited forms of discrimination, but that doesn't mean there is some principle that says all other forms of discrimination are ok. Furthermore, the arguments for discriminating against the obese logically apply to protected categories, so how do you reconcile that?
Apart from logic, I don't understand why anyone would want to argue in favor of discrimination against people who have a tendency to be obese, even if you don't have that particular issue. There are an unlimited number of conditions a person could have that could be similarly discriminated against.
You are describing a world without insurance: where each incident bears its full results on the bearer. This is the situation with almost anything you do everyday: from eating to crossing the street, to wearing helmets on electric scooters.
Insurance as a product is a way to manage that risk, but it doesnt eliminate it, and as a product it makes the total cost higher, as you need to pay to manage the risk. Insurance itself always bears the risk of adverse selections: it attracts those that will have higher tendencies to abuse the insurance.
That is the nature of insurance, what it solves and why it requires human effort to manage, it can't be automated away: it is an economic solution.
Another problem would be: some people have very expensive medical treatment and we should not as a society let them die or suffer death from it. But that problem is not soluble through insurance, that is soluble through charity and charity alone. Using insurance as a mechanism of charity is using a hammer on a screw.
Yes, I was describing a world without insurance. I'm saying a world with insurance and without any of what you call charity is strictly speaking impossible. And therefore the separation between insurance and what you call charity is spurious.
Insurance cannot exist and solve any problem if insurers are able to discriminate perfectly, so it cannot be a matter of principle that they should be able to discriminate to any arbitrary degree.
The idea that insurers are inherently justified in discriminating against poor risks is a nihilistic attack on the idea of insurance.
Total information awareness would lead to perfect discrimination and the annihilation of insurance, so you cannot justify by a principled argument discrimination against those you don't like purely on the basis that insuring them is charity.
> I'm saying a world with insurance and without any of what you call charity is strictly speaking impossible
Truly don't get this. Insurance discriminates before the fact: it's a framework to gauge risk, and collect a premium for managing it. There is no charity involved in that process.
"Just lose weight" is not that simple and it's unhelpful and cruel to imply that it is.
I personally haven't been seriously obese - moderately overweight at worst - but even then I've experienced how difficult/impossible it is to get down to an ideal weight when also dealing with health complications like auto-immunity, stress/trauma/anxiety/depression, or hormonal issues.
I do know others who struggle with more serious obesity, along with some combination of the aforementioned issues, which when you pay attention turns out to being almost always the case with obesity.
"Just lose weight" is simply not possible.
"Just overcome all your auto-immune, hormonal and emotional issues" is really what you're saying, in which case the response must be "OK, give me about 15 years and a ton of support and patience along the way".
“... use the free, safe, and natural solution (eating less)”
Your comment said:
“you should be incentivized to lose weight and do so”
I’m not sure where the nuance is that my paraphrasing failed to capture.
It’s not as if people don’t already have huge incentives to lose weight. Those that have not lost weight are likely unable to for complex physiological or psychological reasons. Telling people to “eat less” amounts to trolling.
If you or the parent commenter have insights on what methods of weight loss could work for people who have yet to find an effective solution, then there might be an interesting discussion. I do have some insights on this, for what it’s worth.
The parent commenter signaled that they have no such interest, hence the downvoting and the ban after their blatant troll comment downthread.
An analogy...people who don't feel pain tend to damage their body. This is mysterious if you think "well, they are not blind, they have free will and the ability to control their body, so why do they let themselves be damaged". But isn't that obviously silly? Pain is very important feedback and if you don't feel it is a disability that you are not at fault for.
Everybody who is naturally not overweight knows that they don't have to rigorously monitor their food intake, because they have an internal thermostat that does it for them. They just eat when they are hungry and stop when they are full.
Some drugs affect that thermostat, and some people have a naturally defective thermostat. It is very very difficult to fight it because the imbalance is very small and the intensity of the output is very high.
The thing that annoys me is, given that I have never been obese, and I assume you have never been obese, we both know from personal experience that people without weight problems do not exert effort to control it. So how can you blame those who need to for being unable? We both know better without needing the least empathy or experience of being obese.
This is an appalling comment that shows you have little knowledge or interest in physiology, and contempt for people who develop obesity as a symptom or a side-effect of medication for serious illness.
A school-friend of mine, who had been an elite athlete during high school and was as healthy and fit as anybody you'd find, developed schizophrenia during his twenties and needed to be put on strong anti-psychotic medication, which caused dramatic weight gain.
He's continued to need various medications for schizophrenia and anxiety ever since, and despite relentless efforts to keep his weight down with the same kind of exercise and diet that kept him in good shape when he was younger, cannot return to an ideal weight.
The reason for this is to do with the way neurotransmitters and hormones alter metabolism, and it's straightforward to understand with a little research.
The question "How do antidepressants create matter from thin air?" amounts to trolling and doesn't belong on HN in my opinion.
"This is an appalling comment that shows you have little knowledge or interest in physiology, and contempt for people who develop obesity as a symptom or a side-effect of medication for serious illness."
I would however, further suggest that not only should we have sympathy for people who have obesity from medication, but those who have obesity without it.
If you take a drug and you perceive God as a result, it is logical to infer that people who perceive God without drugs may be also experiencing something that results from similar brain chemistry.
Yep, that's what I intended to convey; sorry if that wasn't clear.
Sometimes it's a side-effect of a drug. Sometimes it's a symptom of other issues in the body/mind.
My point is that people who are obese (to an extent that causes issues like sleep apnoea or other complications) are not that way because they simply choose to be that way, or because they "just eat too much".
People who can easily lose the weight have already done so. Everyone else is stuck with it, for one or more of any number of complex reasons, and outside observers are in no position to pass judgment.
Don’t be intentionally obtuse. Depression is a bug in the operating system of the mind that impacts everything from motivation to hunger. Pretty hard to lose weight when just getting up in the morning is a feat of willpower and cheap, shitty food is a slightly brighter shade of grey in the dark dull shade of grey that a clinical depression sufferer has as their entire life.
Ever tried debugging a program on a machine with bad RAM? It’s kinda like that.
My point was that regardless of the nature of depression and how well drugs work or don't work, it's well known that psychotropic drugs lead to weight gain and diabetes.
People have an inbuilt homeostatic feedback system which can be naturally out of whack or it can be modified by drugs, and blaming them for not being able to compensate is senseless.
Also, the fact that it can be modified by drugs proves to me that weight gain should not be presumed to be a personal failing. The person who has weight gain didn't become a different person because they took pills.
It's analogous to having a religious experience through electrical brain stimulation - it should make you realize that having such experience is not to your personal credit or detriment.
A very good point. It was hard to know what Yahoo was (or is). In the beginning, remember, they weren't a search engine. They were a curated directory of the Internet. In fact, it was hard for me to realize when they dumped that entirely and switched to a real search engine--despite the fact that I was in this business: I worked for Infoseek!
Those "Honest Ed" signs are beautiful, and remind me of the hand-painted signs I'd still see in Brooklyn in the late 60s and early 70s (probably nearing the end of the era for hand-painted signs)
Orkut’s story had a strange footnote. It was dominated by Brazilian Portuguese speakers, making other users feel less welcome. That was a tough problem.
Well, not for unbelievers, but if he thought their souls would be saved forever (not really clear on the metaphysics but something along those lines), then yes his intentions were good.
We know those intentions have caused a lot of harm. I am not saying he should have been allowed to proceed, but that it is sad that he died.
Well, of course. It’s only fair. You can’t change a rule then go back and hold prior behaviors accountable according to the new rule. It’s just common decency.
I'm not sure how this applies here? This isn't about a retroactive change to Google's misconduct standards for its employees, so no staff are being held accountable according to a new rule.
It's also not about suits between individuals. It's employees seeking damages from Google, so there's no third party outside Google and the plaintiff who could be harmed by the switch. And the plaintiff shouldn't be harmed, because removing the requirement for arbitration wouldn't deny it to anyone who wanted it.
As far as "holding Google accountable for prior events under a new rule", that's pretty much what people were asking them to agree to in the first place. But even worse, Google's statement says all future claims - even about past events - will operate under the new rule. So Google is already going to be held accountable for past events under this rule, and this is just disadvantaging the people who already opened claims.
The prohibition against ex post facto law in government makes sense because they are ripe for abuse. But there are already checks against abuse in the private sphere, including potential litigation for wrongful termination and a desire to keep quality employees. Employees should not be able to get away with poor behavior just because it was not techincally against the rules. When my daughter exhibits a lack of judgment, I might make a new rule; but she's still going to be punished because she should have known better. Employees should know better, and if they don't, they should err on the side of not doing the thing.
Of course, that's not really what's happening here with Google. What's happening is Google stated that the would not force people into arbitration, but they're still forcing people into arbitration.
I wonder what legal standing a private company's "policy" has. Is it written into a contract of some sort, "if you are accused of sexual misconduct, we will follow policy X"? Are all those contracts now being updated?
Realistically, Google can handle this how they want, so I don't see why they can't change how they handle current claims (within reason, of course, I'm sure if your arbitration date is tomorrow, maybe it's bad to change that so suddenly). Of course, Google is going to want to minimize the public knowing about any of these claims, so they'll do what they can to keep it quiet.
I get the feeling that these policies have more value to marketing dept. than the legal dept. After all, there many things that constitute "sexual misconduct" that aren't illegal.
At my company I sign documents. That are tied to money. If the terms were to change -- it would be s problem.
Just because it is called a policy does not mean it can be changed without notice and back dated.
How would you feel if your insurance company retroactively changed their policies on how active auto claims were handed ? Good thing it's not legal for them to do that.
In any case. Google can't always do what the want. The have to follow laws too.
You might be able to void a policy if both the plaintiff and defendant agreed.
I agree. That this is now just a dog and pony show.
It's less of a rule, and more of a change of venue. They 100% should be holding people accountable for this kind of behavior in a public setting to make damn sure the guilty do not victimize anyone else.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021364/