Using Health Insurance To Encourage Healthy Living

I work in a health-conscious office in Dallas-Fort Worth. Throughout the year management brings in fruits and veggies for the staff of nearly 200. They also gift us water bottles, jump ropes and we even have the availability of stand up desk. A massage therapist visits weekly and everyone is granted access to a walk-in chiropractic service nearby.

My company is also completely smoke-free. We weren’t always though, we just have policies that are very good at motivating people not to smoke. I know about this first hand because I used to smoke and I quit due to our policies. How did they encourage my coworkers and I to quit? They motivated us by placing the financial burden of the additional risk that we brought to the group insurance pool, back on us.

From their perspective, it wasn’t fair that my non-smoking coworkers had to shoulder the cost of my poor health choices. Smoking is a choice and the health problems that come with it are completely avoidable if I quit. I could continue to smoke, but I would have to pay for it myself and it would have rightfully doubled my premiums.

High-Risk Health Behaviors

Charging smokers is viewed as socially acceptable and fair because smoking is a well-documented cause of ill health. It makes sense that Sally does not pay more for insurance just because her coworker dings his health 20 times a day with a cigarette. It isn’t fair to penalize good choices and reward bad choices. That is exactly what we are doing when we charge people living unhealthy lives the same premiums as people working hard to stay healthy. As more companies move to penalize smokers with the additional risk they bring to their employees’ insurance groups, we should be looking to encourage other behavioral modifications to reduce risk to the insurance pool and improve peoples’ well being.

Smoking has been the number one cause of cancer for some time and it is still among the leading poor health choices. This is why smoking was an easy target for my company. Smoking-related cancers are 100% preventable through behavior modification. However, smoking has been losing ground quickly as of late to obesity.

The New High-Risk Behavior

Obesity is quickly becoming the largest health issue in America, around 40% of the population is currently obese. It is expected that by the time today’s kids will reach 35, around 60% of the US population will be obese. That is a huge increase in obesity. Obesity is fast becoming America’s epidemic. Making it worse, is the fact that obesity is an almost completely avoidable condition when you simply eat properly and live a more healthy lifestyle. Obesity is completely avoidable except for the .0001% of people with a legitimate medical condition. Thyroid problems and other treatable health conditions are not a reason for obesity, although they are often used as excuses.

As a person who invests a significant amount of my time into fitness and health, why should I shoulder the financial burden of someone who lives a health-destroying lifestyle? Obesity is not the default human condition.  Someone actually has to make a decision to live an unhealthy life. Turning on the TV instead of going for a walk is a choice. Eating donuts for breakfast instead of whole grains and eggs is a choice. Drinking sugary drinks instead of water and pretending like those calories don’t count, is a choice. For the 99.999% of people who aren’t medically induced obesity, everything related to obesity, every health problem or issue you can think of is avoidable. The simple fact is, taking in more calories than your body needs is a choice, and that is what causes obesity.

But does obesity really increase healthcare costs?

Absolutely, for a number of reasons. First of all the idea that you can be healthy and obese has been thoroughly disproven, “Our work shows that so-called ‘metabolically healthy’ obese individuals are still at higher risk of coronary heart disease, cerebrovascular disease, and heart failure than normal weight metabolically healthy individuals.” The article also says that obese people are at a 96% greater risk of heart failure. 96%!

In addition to disease caused by obesity, there is the increased risk of injury. Our bodies were simply not designed to carry so much excess weight. When a normal weight person slips while going down the stairs they are much less likely to be injured. First of all, they can move faster and maybe prevent the fall. If they do fall, there is less weight coming down, so less chance of injury. A normal weight person may walk away with no injury at all or maybe a mild sprain and some bruise. An obese person is much more likely to have serious injuries such as a break or fracture.

Then there is the cost associated to care for an obese person. Many times standard medical equipment is not equipped to handle the larger proportions of obese individuals. More drugs may be required to treat the same conditions. More anesthesia may be needed during surgeries. Surgeries often take longer because the surgeon has a large amount of fat to pass through before actually doing the procedure. Then recovery times and hospital stays are increased because the surgeries are more invasive. Medical treament is just harder when the patient is obese.

Health Insurance Premiums Should Be Determined By Modifiable Risk Factors

Insurance premiums should be determined based on five health markers: BMI, body fat percentage, cholesterol (triglycerides and HDL/LDL ratio),  blood sugars, and blood pressure.

Why these 5? Although BMI can mislabel very muscular people as overweight, paired with body fat percentage measurements it is very accurate. For most people, the BMI measurement is the quickest and cheapest method to determine if their body fat is too high to maintain good health. BMI is also a pretty decent indicator of risk, accurately predicting risks of heart disease, high blood pressure, diabetes and other chronic diseases.

The final three, cholesterol, blood sugar, and blood pressure are all heavily influenced by diet. A person eating a healthy balanced diet, without any untreatable medical conditions, will have good cholesterol, blood sugar, and blood pressure readings. If they do have a treatable medical condition then their medication should be able to keep their levels within normal ranges.

How should we adjust insurance costs?

The easiest way to adjust insurance costs and the least likely to cause objection would be to reward those making healthy lifestyle choices. The simplest way to do that would be with a discount system. Meet certain health markers and you can get a discount on your insurance. The more health markers you meet the greater your discount. Psychology has shown that positive reinforcement is a much better behavior modifier than punitive measures. Giving people discounts to work towards can motivate them to change their life.

So for example:

Person A (athlete):

BMI: normal(5% discount)

Body fat: normal(5% discount)

Cholesterol: normal(5% discount)

Blood sugar: normal(5% discount)

Blood pressure: normal (5% discount)

Person B (self described as fat but fit):

BMI: obese (0% discount)

Body fat: obese (0% discount)

Cholesterol: high risk (0% discount)

Blood sugar: normal (5% discount)

Blood pressure: normal (5% discount)

Person C (skinny fat):

BMI: normal (5% discount)

Body fat: overweight (0% discount)

Cholesterol: high risk (0% discount)

Blood sugar: normal (5% discount)

Blood pressure: Stage 1 hypertension (0% discount)

Person C (healthy diabetic):

BMI: normal (5% discount)

Body fat: normal(5% discount)

Triglycerides: normal (5% discount)

Blood sugar: borderline (5% discount, prescribed diabetic)

Blood pressure: normal (5% discount)

The Desired Effects of Such A Change

The desired effect of this proposed plan is not to stick it to fat people. The desired effect is to get health care costs under control and to encourage people to live healthy lives. Losing weight is not fun. I know, I used to be overweight myself.  It is hard work and can make you feel worse for a while.  Ultimately though, when you are a healthy weight life is better. Everything from the small things like the ease with which you can stand up to the more meaningful, like having the energy to play with your children, is changed for the better. When you are overweight you often don’t realize what a burden those extra pounds are but once they are no longer there, you feel as if you have been set free.

A Web Developer by trade, find me on Github
A motorcycle enthusiast at heart.
Most days I’d rather be in the woods anywhere.