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Don't Tie Insurance Premiums to Lifestyle, Debate Judges and Audience Decide

Above: Debate winner Tsuyoshi Todo, MD. Below: Todo with Surgery Department Chair Bruce Gewertz, MD, (center) and surgical resident Seth Felder, MD, Todo's opponent in the debate.

Plenty of statistics – leavened with good, clean humor and wit – were thrown out during the 10th Annual Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition. The competition played out in front of a standing-room-only crowd estimated at over 300 physicians, nurses, administrators and friends of the medical center.

The debate was a spirited interchange of well-researched remarks as each resident presented his argument. Peppered with verbal jabs, each argument was placed before the audience. The contestants weathered the storm of questions posed to them by the judges. Their closing arguments and summations reflected the intensity of the event.

But in the end, only one argument prevailed. Tsuyoshi Todo, MD, chief resident in Surgery, took home the Morgenstern trophy.

The debate took place April 18 in ECC A-C. This year’s debate focused on whether there should be a link between lifestyle choices and health insurance premiums.

Todo opposed such a policy, arguing that requiring individuals to pay increased healthcare premiums based on lifestyle choices would not only limit access to healthcare, but could raise healthcare costs and create more questions than solutions for the most underserved.

The judges, and an audience voting with its keypads, agreed with him.

Surgical resident Seth Felder, MD, argued in favor of the link. He said individuals who engage in unhealthy lifestyles, such as maintaining a poor diet and smoking, place a larger financial burden on the nation's healthcare system and economy. For that reason they should pay more per month.

Felder said 25 cents of every healthcare dollar is spent treating diseases or disabilities proven to result directly from unhealthy lifestyle choices. Obesity and smoking-related conditions are the most recognizable.

Medical care costs 42 percent more for an obese person than for someone considered normal weight. Likewise, the medical costs associated with a smoker are 40 percent more than those for a nonsmoker. Smoking is considered the No. 1 cause of preventable disease and death, Felder said. Asking these individuals to pay more might create an incentive for them to modify their lifestyle, Felder said.

Already, the federal Affordable Care Act legally ties lifestyle choices to premiums by allowing insurers to charge up to 50 percent more for people who smoke.

"Those who create an avoidable cost should pay an avoidable cost," Felder said.

Todo, however, argued that one emphasis of the Affordable Care Act is to ensure every American has access to affordable healthcare. Increasing premiums based on an individual's lifestyle choices defeats the purpose of the act, he said.

The annual debates are held in honor of the late Leon Morgenstern, MD, emeritus chair of the Department of Surgery and founder of the Center for Healthcare Ethics. Morgenstern died in late December.

Morgenstern's two sons attended the one-hour debate. A memorial service was held for him later that day.

This year's judges were Bruce Gewertz, MD, chair of the Department of Surgery, vice president for Interventional Services and vice dean of Academic Affairs; Sarah J. Kilpatrick, MD, PhD,  chair of the Department of Obstetrics and Gynecology and associate dean of Faculty Development; Beth Y. Karlan, MD, director of the Women's Cancer Program at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, director of the Division of Gynecologic Oncology in the Department of Obstetrics and Gynecology and director of the Gilda Radner Hereditary Cancer Program; Jeanne Flores, senior vice president of Human Resources and Organizational Development; and Robin McCaffery, JD, associate legal counsel in the Cedars-Sinai Department of Legal Affairs.

The Dr. Leon Morgenstern Great Debates in Clinical Medicine Resident Competition is coordinated and moderated by Leo Gordon, MD.

Gordon solicits suggestions for upcoming debate topics. He may be reached at

The response to this year’s debate has been remarkable with accolades pouring in from many segments of the Cedars-Sinai community. The common comment is: "This is the best hour of the medical center year!"

Next year’s debate will convene on April 24, 2014.