Pay more for being overweight or smoking?

Should we pay higher health care premiums at work if we are obese or smoke? This is a thought that upsets many, but the facts are clear - people who are overweight or who smoke cost more to care for.

What about another twist - should people who do not smoke or who maintain a healthy weight get "healthy living" discounts on health care premiums?

It's the same thing, really, but the second "spin" is likely more palatable.

I think it is only a matter of time until this happens at many workplaces and it already is the policy at some. I support this approach because I think we need to give people compelling reasons to encourage healthy lifestyles. And I think that people who cost more should pay more - that's fair. And depending on the amount of extra weight and number of packs they smoke, perhaps MUCH more, like double the cost for weight that is considered mobidbly obese.

What do you think?

Note: Before you send me nasty notes saying I am insensitive or do not understand the plight of overweight people, those of you who have met me know I have a few pounds to lose myself (but I am working on this). I do understand....

Comments

[Sarah]

Wait, I thought recent coverage made the point that smokers, etc are CHEAPER to cover, because they die sooner. Maybe that was just from the government's point of view (i.e. longterm) vs the company's (which would be shortterm). Made me think, anyway.

[Mike DeWitt]

Sarah,

The Social Security program likes smokers for the reason you noted.

As for the point of Lisa's post, the more we can return market incentives to the healthcare system, the better it will work. I pay more in premiums because I'm also insuring my kids. It costs more because the expected costs are higher. No one is arguing about that. Why should this be any different?

Mike

[stephenbooth_uk]

So long as you also up premiums for people who participate in dangerous activities such as extreme sports.

Or you could just go for socialised, free at point of delivery, primary and long term health care funded by taxes on tobacco.

Here in the UK people complain about smokers costing the NHS billions each year, which they do. On the other hand the tax on tobacco brings in about twice the annual cost of the NHS.

Personally I think that extreme sports centres and equipment should be taxed to offset the costs that participants put on the healthcare system when they smash themselves up on a slope, half pipe or the rocks, with an extra premium on surfers for when they get intestinal problems due to surfing in polluted water.

(Two of the above paragraphs were tongue in cheek)

Stephen

[Lisa Haneberg]

Well, Stephen, you must be much more into extreme sports on your side of the pond. Perhaps it is needed to combat the digestive effects of pouring creme onto breakfast cereal. I kid, of course, like you, although the creme is hard to digest.

There are certainly many lifestyle choices that jack up our healthcare rates, but I think that obesity and smoking stand way above the rest in terms of costs and risk factors for major health problems, disease, and death.

[Jennifer Davis]

Bad drivers, those in high-risk neighborhoods, or those prone to accidents pay more for car insurance. Those with chronic health problems or risk factors pay more for life insurance. Why would health insurance be different?

The real challenge comes when rates are based more on profiling than choices people make. What about the health insurance rates for children whose parents smoke? What about the health insurance rates for people whose race, address, religion, or lifestyle make them at higher risk for certain diseases? What about health insurance rates based on the chronic disease propensity of your extended family?

There is also the issue of self-reporting. What kind of monitoring, verifying, or auditing is done to ensure that if you clicked the "non-smoker" box that you don't actually smoke? What if you checked the "I exercise 3 times a week" box. Will someone check to ensure you are going to the gym? Seems a ripe area for fraud if the discount was substantial enough.

[stephenbooth_uk]

Lssa, skimmed (i.e. fat free) milk is far more common than cream on breakfast cereals. I can't even think of anyone I know who puts cream on breakfast cereal.

Extreme sports are very popular in the UK and getting more and more popular (Extreme Eating hasn't really taken off though) and accross an ever widening age range. A skateboarder braving the wrath of the police by grinding a rail in a public square is as likely to be in their 30s as their teens. The biggies are skate boarding, surfing, snowboarding, mountain bikes and body flight (basically skydiving but using a big fan to replace the long fall and avoiding the need for a parachute).

Jennifer, from what I've seen and heard such reductions would probably just be another reason for insurance companies to deny coverage: "You said you go to the gym 3 times a week but in the first week of May 2007 you only went twice. You've invalidated your policy!"

[e cigarette]

Interesting post. I really feel that you are correct on this one.

[E Cig]

That really sucks for these people. Some people can't do anything about it.

Your girl Mary :)

[הסרת שיער]

I think I need and give individuals convincing reasons to motivate healthy way of life and I also think that individuals who price more should pay more that's reasonable. It gives healthy life and body weight.