I read a very interesting quote the other day, and it was basically this:
You will spend time and money on your health. Fortunately, you get to choose whether that time and money is spent proactively or reactively.
Man I thought that was brilliant. I think it also segue's perfectly into this article that just came out in Time Magazine a few weeks ago. It basically asks the question "Should smokers and overweight individuals have to pay more for health insurance than their healthier counterparts?"
I think the answer is absolutely YES. I can only give an example on how my company currently handles it since I know those details.
How much more do you think the insurance premium is for a smoker at my company vs. my premium? $7. Smoking has been proven beyond any doubt to be a death sentence but that person will pay only $7 more per paycheck than I will (I don't smoke, by the way).
How much more do you think the insurance premium is for an obese person with Type II diabetes at my company vs. my premium? $0. We pay the exact same amount.
Anyway, it's a great article, so check it out. I have a few quotes and comments on it below as well.
“North Carolina this year became the second state to approve an increase in out-of-pocket expenses for state workers who smoke and don't try to quit or who are morbidly obese and don't try to lose weight.”
On the surface, I think that policy is awesome! I also think it is fair. It doesn’t immediately penalize someone who smokes or who is morbidly obese. It actually gives that person the chance to change those unhealthy habits. They are only penalized if they don’t try to change their situation.
The one counter-argument I have is where are the rewards for those people who not only maintain good health, but actively seek to continuously improve it?
“Nationwide, employee insurance premiums have increased 131% over the past decade, according to the Kaiser Family Foundation. And it's well documented that smoking and obesity are associated with higher medical costs.”
Given that information, why shouldn't smokers and obese people shoulder the majority of the costs?
CONS:
There are a couple of reasons why such programs are hard to administer. First, for the overweight issue, the plans described in the article use the Body Mass Index (BMI) as their determinant. BMI is a number based on a person’s height and weight that attempts to categorize them into one of four categories: Underweight (<18.5), Normal Weight (18.5 – 24.9), Overweight (25 – 29.9), and Obese (>30).
I just ran the numbers on myself (5’11”, 190 lbs.) and my BMI is 26.5. Holy shit! I’m overweight!
BMI can be effective for quickly categorizing a large population with decent accuracy, but at the individual level it just doesn’t cut it. It completely ignores the fact that muscle has a greater density than fat.
I think systems like this should be in place, but there has to be a better way to administer them. It might mean that actual bodyfat testing and blood tests should be run (perhaps at the expense of the individual). I would pay to have those tests done if it would result in savings on my premiums.
"'We're trying to get across to the population that they have to take responsibility for their well-being and engage in more healthy behavior,' says Jack Walker, executive director of the North Carolina State Health Plan."
Are penalties unfair? What if there are no penalties, but only rewards for meeting certain criteria? For example, from the article:
“In 2005 the Safeway supermarket chain implemented a voluntary wellness plan. Employees who take and pass tests for such things as blood pressure and cholesterol levels can reduce their annual insurance premiums by nearly $800.”
Why are drivers penalized for speeding tickets and accidents? Why are homeowners penalized based on what zip code they live in? Simply, it’s because those people represent a higher risk to the insurance company. So why doesn’t the same theory apply to health insurance? Should those people who are more at risk (obese and smokers, for instance) pay a higher premium than those people who are less at risk?
Your thoughts?
Thank you for the post - you discuss great points. I think it's appropriate to implement financial penalties as long as they are balanced with meaningful incentives. Speaking anecdotally, I find that many people who want to live healthy lives make decisions based on poor information (e.g. spinach cooked with bacon is healthy because it's spinach) or simply don't know how to filter the bad information from the good.
ReplyDeleteTo encourage commitment to exercise, some insurance companies subsidize gym memberships as long as people use their memberships x times per month (it usually amounts to twice per week). The gyms they partner with submit member utilization information to the insurance companies, to balance the incentives with accountability.
If we were to couple this with access to registered dieticians (some plans cover dietetics only if the patient has Type II Diabetes) who can help plan affordable and healthy menus as well as provide tools and support to make healthy decisions, we could balance incentives with accountability to create a win-win situation.
It is unfortunate that Capitol Hill currently focuses primarily on the mechanics of insurance coverage rather than the root causes of our nation's poor health, which if identified, can truly decrease our healthcare costs.
Thank you for sharing the information you find. I enjoy reading it!