Should Health Insurers Charge Overweight People More?

I was flipping through the latest issue of Money Magazine and at the very end was a poll question: Should health insurers penalize people for their behavior?  The two big culprits for medical expenses in the US are obesity and smoking.  We’ve been effective at decreasing smoking (only 21% of Americans smoke these days), but not so well on controlling obesity since 34% of Americans are obese and over 50% are overweight.

We curbed smoking in the US by scaring the bejesus out of everyone with pictures of black lungs and pale people hooked up to ventilators wheezing away.  We added a Surgeon General’s warning to the packaging.  We taxed cigarettes into the stratosphere and made it difficult for people to smoke around others; smoking bans are in place in most public places now and many of the healthy and haughty look down their noses at those who smoke.  My sister got offered a job that was later rescinded when her potential employer learned that she smoked.  This was entirely legal for them to do and it was the impetus to get her to finally quit the habit.

Should we charge by the pound for obesity?

The magazine poll had 31% of respondents in agreement that we should penalize unhealthy behavior.  To the poll responders’ credit, 38% said no to penalties, but felt insurers should offer incentives to help people live a more healthy lifestyle.

The American Lung Society heavily promotes the Great American Smokeout, a random day chosen to encourage smokers not to light up for 24 hours, and maybe quit altogether.  ALS offers lots of support and corporate sponsored programs and t-shirts and water bottles.

Should the American Obesity Foundation (I made that up) create the Great American Scale Day where everyone who is overweight gets weighed and embarks on a rigorous diet and exercise program?  Is anyone getting uncomfortable yet?  Does anyone feel Big Brother breathing down our necks?

We took cigarettes off the shelves and sequestered them behind counters, available only with proper ID.  Will we be forced to do that with Doritos too?  Yeah, right…

There are some parallels to both health problems; most smokers don’t want to be smoking, and most overweight people don’t want to be overweight.  But there are some pretty distinct differences, most glaringly that smokers can live without cigarettes, but people can’t live without food.

So what are some smarter ways to address the problem? Here’s some options:

Encourage grocery stores to reorganize their shelves to put the healthy stuff at the front and the not-so-good stuff in the back.  Feel free to cut down on the availability of unhealthy stuff, too.

Educate children on how to eat well.  I was sadly shaking my head watching Jamie Oliver on his TV show in front of a class of grammar school students who couldn’t even identify a potato.  These kids had only ever seen processed food!  Teach them to eat well and maybe they’ll shame their parents into making better choices.  That’s what the green movement is doing and it’s working wonderfully as children make their parents swap out incandescent light bulbs for flourescents.

Continue to ramp up and fund the US government’s campaign against obesity.  Michelle Obama’s “Let’s Move” plan is targeted towards kids but it will spill over quickly to adults for the reasons mentioned above.   By getting the message out there, over and over again (like the smoking campaigns of the ’70s and ’80s), we’ll provide people with information and educate them to make wiser choices.

Calorie labelling in all restaurants. This trend has started coming to the larger chains, but I’d love to see this trickle down to every restaurant we visit.  It’s really not that hard to figure out the calories of a dish.  Simple computer programs do it in a few minutes.  In New York state where this law is already in effect, researchers have already seen changes in behavior; people are choosing the lower calorie, and presumably healthier, meals.

Give the biggest risk groups more tools. Inner city kids need safe places to play and burn off energy.  When revamping school lunch programs, start with the poorest school districts and work our way up.  The upper middle class has the least problems, statistically, with obesity.  Put the money where it really needs to go first.  If we can turn around our poorest schools successfully, then it should be easy to encourage the more affluent ones.

What would you do?  Should health insurance companies charge “by the pound”?  Please share your thoughts.