Should obese people pay more for medical treatment

Should grave people behave more(prenominal) for medical kickshawment fleshiness is an incredibly expensive disease, both for the patients and the hospitals. Aside from being a disease which is associated with many further complications and problems, which themselves lead to an increased bell, this disease also requires costly medication and specialised equipment for diagnosis and treatment. This results in a condition which has turn up extremely costly to nearly all parties involved. It has been reported that 47 million was spent purely on anti- fleshiness drugs in the fiscal year of 06 to 07.1 This figure, coupled with the point that the prevalence of adult obesity in the U.K. is above 20 per cent and set to rise10, signifies the incredible cost associated with this disease and, in turn, highlights the growing problem of obesity on a social and economic scale. Its a problem that understructuret be ignored, and throughout the course of this paper I will attempt to iron out a nd evaluate both sides of the argument Should obese people even up more for medical treatment?, in prescribe to find a resolution.First, before jumping in to the crux of the fountainhead, it is imperative to establish the importance of the NHS as well as its core principles, in order to allow a fully in-depth psychoanalysis of the head word at hand. The NHS, which is the primary healthc atomic number 18 provider in Great Britain, was set up in 1948 with one of its key principles being the health benefit will be available to all and financed entirely from taxation, which means that people pay into it according to their means.2 It is important to stress the intelligence information all in the sentence. This word refers to the estate as a whole, regardless of their medical condition. The importance of the NHS clearly butt jointt be stated enough, a nation replete(p) health service which aims to treat all without directly taking money from the patients, is vital to maintaining the infrastructure of the country. It would seem then that the very nature of this question would debate the core principles established in the set-up of the NHS, however in the recent light of the current economic smirch and plain proposed budget cuts3, the question raised could one day become a reality.It is important to first define and explain obesity ahead of tackling the ethical dilemma which is the title of this paper. One definition would but be too some(prenominal) be fat on an individual, while this is somewhat entire, it is also incredibly basic and not at all scientific. The BMI ( torso mass index) measurement is one of the nigh straightforward and useful techniques to establish the condition of obesity. The BMI is calculated by correlating a relationship surrounded by the height and weight of an individual, it is used by many organisations more or less the world such as WHO and NHS. The formula for calculating the BMI isThe results gained from the BMI quite a little be classified in table 1 in order to specify the special(prenominal) weight class of an individual.ClassificationBMI (kg/m2)Principal cut-off pointsAdditional cut-off pointsUnderweightSevere thinnessModerate thinness16.00 16.9916.00 16.99Mild thinness17.00 18.4917.00 18.49Normal direct18.50 24.9918.50 22.9923.00 24.99 weighty25.0025.00Pre-obese25.00 29.9925.00 27.4927.50 29.99Obese30.0030.00Obese class I30.00 34.9930.00 32.4932.50 34.99Obese class II35.00 39.9935.00 37.4937.50 39.99Obese class III40.0040.00Table 1. adapted from WHO turn the use of the body mass index to calculate a persons weight class is used worldwide it has a fair number of shortcomings and flaws. For instance, this table of classification for BMI is not sexual activity specific, so it is applied the same for both males and females equally, as well as this, it also doesnt account for weight distribution in individuals nor is it possible to consider study or muscle mass, both of which be heavier than fat. These problems will hold more significance later in this essay while discussing how obesity should be defined.Obesity is scored by a variety of different factors. These include genetic susceptibility, socio-environmental factors, malfunctioning appetite regulation or may also be a cause of new(prenominal) diseases, such as Cushings syndrome.7 dapple it was previously thought that obesity was caused by a lack of willpower or a lifestyle choice, more recent studies have discovered that obesity is a chronic disease, involving a number of different biochemical and metabolic processes comp ard to individuals who bent obese.8As stated previously, obesity is conjugated to many more serious health conditions and illnesses. Examples of these include diabetes mellitus, increased cholesterol, coronary mall disease and hypertension amongst many others.7 It is important to discuss the seriousness of these resulting conditions in order to fully comprehend the fatality of obesity. Diabetes mellitus (otherwise known as slip II diabetes) is a serious condition which occurs when the body either does not produce enough insulin or the cells do not properly react to the insulin produced. This condition is said to affect approximately 2 million people across England and Wales, supposedly with a further 750, 000 unaw ar that they have this condition.4 Type II diabetes can also lead to kidney disease, nerve damage or even strokes. Coronary heart disease is another serious condition which can be caused because of obesity, which affects almost 300, 000 people a year in the U.K.11 on that point are multiple actions that can be taken in an attempt to treat or cure obesity. These include dietary therapy in order to regulate the number of calories taken in by an individual, and to maintain that over a long-term period. Other methods which may be used in conjunction with this may be increased exercise, to seize with teeth off calories, weight loss surgery, suc h as gastric band surgery or possibly drug therapy, which is often used as a last resort. It should be noted that not one of these methods are able to fully treat obesity alone, instead they must be used in unison depending on the severity of the disease and also the individuals diagnosed with them.It apparent that obesity is an incredibly complicated disease in terms of the causes, secondary factors and treatments, all of which conduct towards a confusion regarding the nature of obesity in the minds of the public as well as upping the cost delinquent its many treatment techniques, none of which can be considered 100 per cent effective. This encompasses all of the aspects of the disease, which is often described as an epidemic, as its a growing upkeep, and the economic burden attached is sure to prolong strong opinions regarding the question of this paper.Now that the importance of the health care system has been established and the medical significance of obesity has been recog nised, the essay question itself can be discussed. The initial views on this topic are polarising, with some instantly believing that the obese should pay more for the disease that theyve inflicted upon themselves, believing that it is unfair that the rest of the nation should pay the cost. Others imagine that they shouldnt pay the financial cost, stating that the NHS was set up to help all, despite whether or not their condition is self caused. The argument can even be pushed further, extrapolating that smokers, whoop it upers and even athletes would also have to pay for the medical costs for their diseases or injuries, because, by that same logic, these conditions are also self inflicted. Although there are for certain some truths to be had in these two contrasting opinions, the two sides of the argument will be investigated and examined on the grounds of ethicality, societal and fairness in an attempt to scram about some form of a resolve on this controversial topic.One of th e primary factors for the argument for obese people having to finance the treatment of their medical condition is that the disease they are burdened with is self inflicted, which is to say that they literally brought it on themselves, so should then have to deal with the consequences. While there is some validity in this argument, it isnt quite as black and white as it may initially sound, with many further complexities set to arise. Those that oppose this argument, are likely to call discrimination, as this ideology that separates a certain type of people from the rest and forces them pay more, which is highly unjust. Also, by this same reasoning, and in the issue of fairness, other patients with self inflicted disease should also have to pay more for conditions and illnesses which they have brought upon themselves. Such conditions would include lung cancer for smokers, liver disease for those who drink as well as injuries to sports players and athletes, as these are all, to some degree, self inflicted.A counter point to this counter point would be that smokers and drinkers already pay more through an increased tax for the drugs (i.e. cigarettes and alcohol) which lead to the individual diseases, so an alternative, or possibly in addition, to forcing obesity patients to have to pay for medical treatments would be to raise the tax on foods with an increased calorie count. This may also be used to deter away from choosing these pro-inflammatory foods as well as generate income from those who cost the NHS so much money in its treatment for obesity. However, this would result that members in the public that fall in to the normal weight range would also have to pay the increased tax for these same foods, if they choose to occasionally indulge. This, at first glance, seems like a fair compromise, as smokers who dont cost the NHS with treatment for smoking related disease still have to pay the tax on cigarettes, however, the idea comes full circle that people who arent obese are still having to pay lifestyles of the obese, indirect as it may be, which is one of the main points evoking the question at hand.There is evidence to suggest that those who are obese are also more likely to be in lower paid jobs, and as such, have less expendable income. This may be because those with lower income are more likely to live in poorer areas and where healthier, more nutritious foods arent as readily available or outside of their budget. This may also be due to a discrimination present against people who are obese and overweight. Employers may be more likely to hire those who arent overweight as they see their might to resist overeating or staying in shape as a good quality in what Acs, Lyles and Stanton (2007) describe as a willingness to delay gratification. whatever the reason may be for the correlation between being overweight and having lower income, the fact remains that the lack of capital possessed by the obese population would prove to be incre dibly troublesome if obese people were to finance their medical treatment in this manner. The case for increasing the tax of unhealthy foods may be less applicable as it may push both healthy foods and unhealthy foods out of reach for poorer and obese population financially. To smite this, healthier foods have to be made cheaper and more widespread, which may again be difficult given the nature to produce healthier and organic foods are likely to cost more. Even so, it would seem any loss made would surely help the NHS spend less on obesity, which, in the 2007, was estimated at 4.2 billion.6The founding for this particular argument is on essentially boils down to the thought that obese people are obese solely because of their own doings, which many people believe to be an accurate portrayal of reality. However, this statement by no means holds true to the complete population of obese people. There is a genetic link up associated with obesity, with the inheritable risk of obesity thought to be approximately 30%.7 Many genes have been found that code for weight control hormones, and a stain in these genes may be passed on the offspring, thereby increasing the chance of obesity in that child.5 This would bring about many more questions and dilemmas concerning the topic at hand. For instance, what if the cause for obesity was mainly genetic as opposed to being environmental? Should the patient still pay more even though, by definition, this type of obesity isnt necessarily self-inflicted? Some may answer this question by stating that those with genetic factors shouldnt pay, however, what if both social and biological factors play an equal role in the cause of an individuals obesity? Or, further throw a fiting on the idea that those found to have the genetic link shouldnt pay, how would the obesity genes be examined in the patient? Genetic interrogatory may be carried out, but performing these tests on the entire to obese population in order to determine who should pay these costs would itself be costly, therefore being counter-productive where one of the primary aims of the question raised is to cut back on money being spent.There are also further complications regarding this wide held belief that obesity is self-inflicted. Are cases where individuals are driven to high calorie, comfort foods because of bullying or depression, be considered self-inflicted? Also, who should pay the cost for cases of childhood obesity? While some may point the fingers at the parents, one would have to ask if that is at all fair. For instance, parents arent sentenced for the crimes that their children commit. Evidence exists which associates an addiction to eating (as well as other addictions) with mental illnesses.9 Should these cases also have to pay for medical treatment themselves? By this same merit should schizophrenics and patients with other mental conditions have to finance their treatment?There are a host of other problems and issues which are p resented if this question is to be seriously considered. The question of affordability and practicality surely arises when applying the theoretical question to a real-world scenario. If obese patients were to pay directly for their medication, surgery or weight-loss programs then how much should be charged? It would surely have to be a fairly significant amount as the cost of obesity itself is already at an extremely costly figure.6 Having to pay for medical treatment may create a divide between patients who can and cant afford the costs, possibly adding another level of discrimination. And what if patients are unable to meet the expense of these bills? Should they be denied treatment? Anything beyond entertaining this idea would bring about huge moral dilemmas, as the hospitals would essentially be playing God, deciding who lives and dies, based purely on their financial background.Also, the practicality of such a situation is likely to bring up further complications, with one ques tion being how should it be charged? The NHS wasnt set up to accept payments in this particular manner, so how could this be accomplished? Would the patients need to pay before their medication or surgery? If so, and the patient does not pay, it will again bring up the judgment of denying treatment to patients. There is also the possibility that patients would pay post-surgery. But if they refuse to pay or cant afford it, then some form of policing body would need to be enforced to ensure these payments are made. While this will cost more money, again a problem given the nature of the question is to decrease the money spent, it also sends out an image of the NHS reminiscent of some sort of mobster loan shark.Another issue when considering this subject is the concept of delimitate obesity. Earlier I have stated the use of the BMI system to define obesity the world over, as well as outlining its fundamental flaws. A concern with defining obesity with the use of the BMI scale is that the differences between being classified as overweight or obese may literally be a few inches in height or a few kilograms in weight. This may very well create scenarios where a person may be a few inches shorter than another who is the same weight having to pay more for treatment. This could possibly be countered by measuring obesity by more methods than simply BMI alone, which is currently in place to diagnose obesity by the NHS. Other methodologies may also have to be in place in order to diagnose or differentiate between different classes of obesity. These could possibly include calculating the waist-to-hip ratio (WHR), Waist circumference (WCR) and Skinfold thickness.7 together these allows for a more accurate representation of a patients physical status, allowing to charge for medical treatment accordingly, if that path were to be taken.It is clear that any attempt to find a solution to this question brings up series of arguments and counter points which negate and nullify ea ch other, and instead of establishing a concrete formulate of action, it would seem that the wisest and safest bet would be to sit on the fence. My personal opinion on the matter would be to increase the tax of unhealthy foods and make healthier foods readily available and at an affordable equipment casualty as well as pushing for a more active lifestyle, something akin to the change4life scheme recently set up by the government. Though this isnt without flaws, it certainly seems to reach a form of middle ground in term of ethics and equality. One of the main aims of the NHS was to treat all patients who pay tax, so forcing a section of people to pay more, regardless of whether or not the condition is self inflicted, opposes its key ideologies as well as being highly discriminatory. My proposed plan of action is certainly more subdued and the benefits of which would only be realised after a longer period of time, however, it strikes a fair balance between staying true to the NHS p hilosophy, equality for all an attempt to treat obesity and healthy lifestyle.The report should be similar in overall style to the topic discussed in NelsonsIssue II (Human Organ Transplantation) above. Another example for style couldbe a Scientific American article (e.g. How breast milk protects newborn(December, 1995) by J. Newman, pp58-61).The essay should cover the basic science, including recent developments andongoing research, but should focus on examination of the ethical, social and legalissues related to the topic.1.More than a million anti-obesity prescriptions were issued in England in the last financial year at a cost of 47million. It means about 88,000 people could be on a course of treatment.http//www.thisislondon.co.uk/ newsworthiness/article-23406735-pills-not-the-answer-to-obesity-says-top-doctor.do2. http//www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspx3. http//www.nhs.uk/NHSEngland/thenhs/nhshistory/Pages/NHShistory1948.aspxhttp//news.bbc.co.uk/ 1/hi/health/8012588.stm4. http//www.nhs.uk/conditions/diabetes-type2/Pages/Introduction.aspx5. Bouchard 19946. http//www.healthcarerepublic.com/news/934442/Cost-obesity-NHS-England-rise-62-billion/Acs 9781845425005 , obesity, business and public policy.7. Tomlinson8. brock9. truth mental illness 978075730107010. http//www.who.int/infobase/report.aspx?rid=118iso=GBRDef_Code=cd.0701Survey_Year_End=2005genGraphButton=Generate+Graph11. http//www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx?url=Pages/What-is-it.aspxred expandblue unsure