Commenting on "Should People Who Don’t Take Care of Themselves Pay More?"
Maggie,
Great post re: higher premiums for lifestyle choices. I am a physician interested in public health and policy and have grappled with the issue you write about. Having thought about the same upsides and downsides you review, I have to say, my heart and brain remain conflicted. My heart agrees with everything you are saying. My brain tells me that with obesity though, especially in view of the rise in this epidemic over the last 20 years (our genes have not changed, ask Michael Pollan), some incentives need to be on the table.
Yes, by penalizing BMI over 30, we will be hurting the 5-10% who truly have a "disease," but conversely, we will sending a message to the rest of the folks who need to lose 10-20 pounds (by staying away from seconds at the all you can eat counter, etc). I do believe we can make a small, albeit a significant impact by tweaking the premium–high enough for people to notice, low enough not to break the bank.
The difference might save a billon here, and a billion there, and this savings can be ploughed into other areas of prevention, etc. Pure conjecture, but I do feel it is legitimate and will have a salutary effect.
Also, although it is a semantics game, and you point this out, I do feel a healthy lifestyle should earn you a discount rather than the "equivalent" penalty for remaining overweight.
Smoking, and for sure, alcohol, are likely different animals. However, at least for smoking, my "heart and brain thing" applies once again. As a society, despite the penalties, even with the "addiction" concerns, we need to send a message that your habit is dangerous and costing society. Will it hurt some? Of course, but in the aggregate I think it is not inappropriate. My two cents.
Anyway, I could prattle on, but you get the thrust of my message. Thanks for a great blog and keep it up.
Bradley Flansbaum DO, MPH
NY, NY
