This is a follow up to our last post about how obesity has a huge impact on health care usage, and therefore contributes heavily to skyrocketing health insurance premiums. Most Americans with health insurance get their coverage through their employers. Group health insurance through an employer is required to cover all qualified employees, regardless of medical history. An employer can set certain standards, such as number of hours worked per week, but then anyone who meets the employer’s requirements and enrolls with the health insurance policy will automatically be covered. Employers are required to pay a portion of the premiums, but as rates go up, they are increasing the amount that they require the employee to pay for coverage.
I think that the non-discrimination on group health insurance policies is a solid foundation for providing coverage to everyone who needs it. If insurance companies could charge more to unhealthy employees (and still require the employer to pay the set percentage of the premiums) it would give employers motivation to discriminate against applicants with health conditions. However, I think that the ideas behind how group health insurance premiums are set up need to be re-evaluated in light of the ‘obesity epidemic’ we’re currently facing. The numbers are ridiculous in terms of how many people are overweight or obese, and the health care costs directly related to obesity.
So here’s my out-on-a-limb idea. I know this isn’t politically correct, since we’re supposed to think of obesity as a disease just like cancer or Parkinson’s, but I think that people should be held more accountable for their weight. I’m not talking about people who are trying to lose those last 10 pounds. I’m talking about people who are dramatically overweight, and who have (or are at high risk for) serious illnesses that are directly linked to obesity – things like heart disease and Type II diabetes.
Currently, group health insurance providers have to charge the same rate to each member of a group within the same age range. For each group, age is the only factor that determines differences in employee rates. Obviously someone with dependants pays more than a single employee, but if you compare two same-age employees at the same company, each with a spouse and child, or each as a single employee, their rates will be the same. But maybe if one of those employees weighs 350 pounds, he should be charged a higher rate for his policy. And his employer should not have to pay any of the extra charges. I’m very much in favor of subsidizing health care across groups, so that people who have claims don’t all of a sudden end up with outrageous premiums. But I think that it’s time that we hold people accountable for their own actions and how those actions are impacting health care costs and insurance premiums.
Obviously, this creates a grey area in terms of how much we can realistically hold people accountable for their own health. Obesity – in the vast majority of cases – is an issue that is behavioral in nature, and can be changed. This is in contrast to someone who was born with a congenital heart defect, or Type I Diabetes, and has a chronic illness not caused by a behavior or lifestyle choice. People with MS cannot rid themselves of the disease by changing their behavior. True, there are lots of things that they can do to lessen the symptoms and progression of the disease, but they don’t have a choice to make it go away entirely. This is not true of someone who is 100 pounds overweight and suffering from hypertension or sleep apnea, or a host of other conditions that plague obese people. If this person makes the choices required to lose 100 pounds, his or her health will dramatically improve.
Because of this distinction, I believe that group health insurance carriers should be allowed to charge a significantly higher premium to people who are obese. I do not think that an employer should have to pay any portion of this price increase. I think that health insurance providers – both group and individual – should focus on preventing obesity. But there’s no getting away from the fact that it’s the choices each of us makes on a daily basis that determine whether we’re actually taking responsibility for our own health. And I don’t think that employers or employees who are choosing to act responsibly should be subsidizing health insurance premiums for people who are choosing to be unhealthy. And in the end of the day, that’s what obesity is.