Earlier this week, I wrote about the idea of employers charging an additional premium to obese employees who don’t make an effort to slim down. Bob at has written about the topic , and his post was included in the Cavalcade of Risk this week.
Bob takes a similar view to mine – basically that employers pay a huge sum of money for their employees’ health insurance benefits, and if they want to pass on a little more of those costs to employees who are obese, or those who smoke, they are well within their rights to do so. We know that smoking and obesity lead to higher medical costs, so it makes sense to have those employees contribute more towards their premiums.
But the comments on Bob’s article are where things get interesting. Whenever this topic comes up, there are invariably references to people who are overweight because of conditions beyond their control. I do not dispute that this is the case for some people. Just as some people are born with heart defects that make them more likely to suffer from heart disease later in life. But there are also a good number of people who eat poorly, lead sedentary lives, and then end up obese or with heart disease – or both.
In Colorado, nearly one out of every five people is obese. And we’re the thinnest state in the US. Across the country, the numbers have been rising for years, and obesity accounts for a huge amount of health care spending. It makes sense to me to charge additional premiums for things like smoking and obesity, which are generally self-inflicted, and absolutely increase health care expenses in the long run. Overall, I don’t agree with the idea of charging people for their health insurance based on their actual health care usage – that could be a slippery slope to defeating the purpose of health insurance. The idea is to spread risk over a large population, with everyone paying into the system so that those who end up needing care (and we never know who that might be) can get it without going bankrupt. I am not advocating for a change to that ideal. But if an employer wants to pass a little more of the cost on to an employee who makes choices that ultimately end up costing the group more money in health care expense, so be it. (Employers still shoulder most of the weight of the premiums on group health insurance plans, even with these small surcharges for smoking and obesity that we’re seeing lately).
So then there’s a discussion about whether obesity is generally a self-inflicted situation (I don’t think this is really debated for smoking). For some people, with ailments likeDisease or PCOS, weight gain is a result of the underlying condition. But instead of looking at individual scenarios, let’s look at the big picture. And just for the sake of making a point, let’s take an extreme view. What if everyone in America were to become a vegan tomorrow. And had to start biking or walking anytime they were going somewhere within five miles of their home. Extreme, maybe. But I warned you. Anyway, what do you think would happen to our obesity rates? If obesity in the US is not self-inflicted, one would expect to see no changes in the levels of obesity following a dramatic change in our lifestyles. Of course this experiment isn’t likely to happen any time soon, but if you had to make a bet one way or the other, what would it be?