Saturday, October 01, 2011

Should overweight people pay more for health insurance?

Usually I find The Jillian a pretty good source of information and entertainment, but I disagreed with her rant on the latest episode of the podcast (Overweight to pay?) that insurance companies should charge overweight people more for health and life insurance (or the seemingly nicer tactic of charging less for people in a "healthy" weight range).  Or, more accurately, I disagree that doing so would result in truly lower premiums for healthier people or provide incentive for people to lose weight in a healthy way.

First of all, any time you decide to test people for anything, there are costs involved.  Florida's legislature found that out when they decided to require drug tests for welfare recipients.  There are the costs for the tests themselves, plus the costs of tracking the results, and the cost to defend against lawsuits resulting from the law. Plus, they were only able to deny welfare benefits to a small percentage of the people who applied (a percentage lower than the suspected drug use rate among the general population), and though the legislature might derive some satisfaction from starving those people's children (who presumably have no control over whether their parents use drugs), the actual savings were not that great because of the other costs.

I think this is a pretty good parallel to Jillian's insurance proposal.  Insurance companies (unlike state legislators) are pretty good assessors of risk. That's how they make their money. If charging more for health insurance for overweight people was really worth the costs, they would already be doing it.  Unlike the Florida legislature, they also have to compete for customers, and they probably know that most customers would not want to have to weigh-in regularly with their insurance company.  Plus, of course, there would be administrative costs associated with the weigh-ins, and possible discrimination lawsuits.

Assuming that such an initiative passed, it might not have the desired effect. Presumably, overweight and obese people already want to lose their excess weight even more than insurance companies would want them to, and they have not managed to do so not for lack of trying, but because healthy weight loss is slow and difficult.  (I speak from experience here) and there is a lot of conflicting information about what kind of diet and exercise is most effective. Imposing a financial penalty for excess weight might encourage customers to try dangerous and drastic weight-loss measures that could result in excess costs from, say, extreme diets or harmful supplements. Or more of them might ask their insurance companies to pay for costly weight loss surgeries. The kind of moderate behavioral modifications that would result in the healthiest weight losses might take years to bring an obese person into a healthy BMI range.

Finally, there is some evidence to suggest that weight is not a highly accurate predictor of health.  The simplest method of determining who is overweight or obese, BMI, has been shown to inaccurately predict body fat percentage in many adults.There is some evidence that suggests that excess weight is not a health risk for some obese people, especially those who exercise regularly. One study even found that people who fell into the "overweight" BMI range had the lowest risk of dying from all causes. It may be that excess weight is just a marker for the real risk factors: A sedentary lifestyle and a poor-quality diet.  For people who have addressed those factors, excess weight might be more of a cosmetic issue than a health problem (or at least that's what I'm hoping).

Ideally, any incentive would be attached to behavior, rather than weight. I know of quite a few employers who provide free or reduced-price gym memberships to employees, and even cover the costs of some weight-loss programs and smoking-cessation interventions, in an attempt to address the behavioral side of the problem and reduce their health insurance premiums. These companies are creating a win/win situation: happier, healthier employees and lower absenteeism and health care costs. These incentives also probably increase their competitiveness for good potential employees.

I would like to know how much those incentive programs pay off for companies, if at all. I would also like to know what the costs/benefits of the pay-to-weigh program that Jillian is proposing.  Somehow, I think the insurance companies have analyzed the situation more than Jillian has and probably already have the answer.


  1. Excellent post! As you say, it's highly likely that insurance companies have already analysed the costs/benefits.

  2. Anonymous5:41 PM

    I think the idea of charging the overweight more for insurance is so stupid. I am the most overweight person in my department at my job and I have taken the least sick days. I have no serious health problems. I don't feel that I should have to pay more than the ones who go to the doctor for the attention it gets them. Why not charge the older people more? They are the ones who get long fatal illnesses. What about charging people with children more? Kids are always at the doctor! Fertile age women are always having kids,how about charging them more? Middle aged men-always having those heart attacks, make them pay. SMOKERS....?
    Actually it is most fair to charge everyone THE SAME because at one time or another we will all go through the same life cycle changes. I just think attacking the overweight is so unfair and the fact that it's allowed is so wrong. Insurance pools are supposed to distribute the risk. Isn't that why we have them? Why is this even an issue? If someone has a mentally ill child or wife or a kid with cancer do we charge them more? Why charge fat people more? Oh, it's a lifestyle choice, that's it. NO it isn't. No one wants to be fat. I have no idea why I can't lose this weight. I am healthy and I am sane. I have lost it a few times but it always comes back. I can't control the compulsion to eat. Sorry, that is just how it is. I do feel it is something hormonal like leptin or some other chemical imbalance. I wish someone had an answer,but till they do: I am sure that pressuring fat people to be thin will work about as well long-term as pressuring fish to climb trees.

    1. Anonymous4:46 PM

      hmmm should a guy who has crashed more cars pay the same rate as a guy who hasn't crashed any cars on their auto insurance? No. Should a chain-smoking pregnant child who is overweight pay the same as a pregnant child who is overweight on health insurance? No. more implied risks = higher cost. how is that so hard to understand.. Whether or not the rates overall are justifiable is the only debatable issue here.

  3. Anonymous2:00 PM

    I totally agree with Anonymous. Overweight folks already pay more for things like airline seats. Yes, Jillian may have been overweight earlier in her life, but now it's her job to stay slim.

  4. For me it was less that Jillian thought that overweight people should pay more than her statement that "If you're overweight, it's your fault." Seriously? After all the times she talks about how big a part things like trauma, upbringing, poisonous food supply, modern conveniences, etc. play in obesity, suddenly it's like deep down she believes it's 100% personal responsibility. That's something ignorant people think, and I can't believe that not only that came out of her mouth, but that she stands by it.

  5. Great points.

    Life insurers do charge more (at least mine does).

    While there is good evidence that fatter people are more expensive to care for, there is also conflicting evidence (the CDC study). Are they also going to charge more for people who don't wear helmets, binge drink, smoke, etc?

    I admit I am wary of suggestions from a woman who's stated she doesn't want kids because she's worried what it will do to her body. Sheesh.

  6. 1. I do pay more for life insurance:

    2. My entire family - two fat parents and FIVE children barely used $1000 on our health insurance last year. My husband had NO sick days for the entire calendar year.
    I even had a homebirth complication free and paid out of pocket.

    3. I just wish there was NO health insurance. Let me pay for my shit out of pocket then it won't be anyone else's damn business how much I weigh. Health care costs would be better regulated if it came out of pocket anyway.

  7. Anonymous2:06 PM

    Insurers DO charge more- or flat out deny coverage- for obesity.

    When I left my previous job to accept a position in a company much closer to home (commute 8 minutes instead of an hour and a half) I had to accept that my new company didn't have health insurance. What I didn't know was how difficult it would be to get coverage, due to being obese. Blue Cross denied me outright, as did Aetna, both citing my weight. Another insurer, Celtic, accepted me but at nearly twice the standard rate for someone of my gender/age. I am active and have no other health issues. I also have to say that it did provide a wake-up call to me because I was now seeing, in the form of a monthly expense, what my add'l weight was costing me. I switched doctors, was diagnosed with Hashimotos Thyroiditis, began treatment and have since lost 35 lbs. I don't know if I would have done that if I hadn't seen what my weight was costing me every month.


"Count your calories, work out when you can, and try to be good to yourself. All the rest is bulls**t." -- Jillian Michaels at BlogHer '07