BMI and your health insurance premiums
While Rusty touched on this aspect of the role of employers in enforcing some notion of promoting reducing cost for premiums through wellness programs using ‘carrot or stick’ incentives comes further discussion via Truthout on the changing role of health insurance in America:
Numerous companies have redefined their health care incentive programs, focusing on punishment instead of positive reinforcement. Moreover, many of these so-called “health” initiatives center around a single goal: losing weight.
CVS Caremark, which employs over 100,000 individuals in the United States, recently announced that employees who do not submit to body mass index (BMI), blood glucose, and cholesterol testing and report their results to the company’s benefit firm will face a fine that amounts to $600 annually.
In a statement released by the company, CVS outlines the rationale behind its new program. It states in part: “our benefits program is evolving to help our colleagues engage more actively to improve their health and manage health-associated costs. An initial step to accomplish this goal is a health screening and wellness review so that colleagues know their key health metrics in order to take action to improve their overall health, if necessary.”
I am OK with charging people for their behavioral choices and outcomes. My car insurance goes up if I get a DUI or have speeding tickets. Why shouldn’t insurers and providers do the same thing for health insurance? This of course protects private insurers bottom lines at the expense of the insured but absent some form of coercion by the state, society or the insurance industry, why would fat people ever lose weight?
Perhaps it would be better to start off with a $600 higher premium and offer a rebate to those who submit to body mass index (BMI), blood glucose, and cholesterol testing and report their results to the company’s benefit firm. I think it has clearly been shown that low BMI, low blood glucose, and low cholesterol lead to lower healthcare costs.
What is the difference between charging extra for people who are in a specific category and giving people a discount for people who are not in that category?
Obesity is a major risk factor for diabetes, heart disease, various joint problems and cancer. Reducing the incidence of obesity would be a major public health benefit as well as reducing the healthcare cost burden on society, regardless of whether we continue with private insurance or eventually move to single payer.
So when is CVS taking all of the candy, junk food, cigarettes and dangerous supplements off of its shelves? If they really cared about health, that would be a good start. We also know that for some people, genetics and environmental factors can play a big part in obesity and diabetes. I also know some very thin type 2 diabetics who eat right and exercize. Why should they have to forfeit their privacy? This is part of the utter wackiness of tying health insurance to employment. The only sane solution is a single payer system that is not tied to employment.
jerry has a better understanding of human psychology than joel.
but neither joel nor woolley seem to have much regard for the idea that “obesity” is a “pre-existing condition,” and one purpose of universal health care would be to not punish people for pre existing conditions.
you both seem to have the idea that being fat is a lifestyle choice and something bad people do, and therefore something “society” has a right to punish.
of course by handing over our “universal health care” to the corporations, we can pretend its merely an arms length right of the employer to reduce his costs.
maybe i’m turning into a conservative as i get old, but it seems to me there ought to be a limit on what employers or “society” can demand of mere human beings on their off time.
“maybe i’m turning into a conservative as i get old”
No, just a tedious crank. Stick to SS funding. It’s the one thing you know about. On nearly every other topic you post on, Dale, you’re just a run-of-the-mill geezer.
“you both seem to have the idea that being fat is a lifestyle choice and something bad people do, and therefore something “society” has a right to punish.”
You seem to know nothing about my ideas, Dale. You obviously know nothing about healthcare or obesity.
Being fat *is* a choice for most Americans. That is simply a fact. As for punishment: well, we “punish” alcoholics, tobacco smokers, and drug abusers. Many states “punish” people who don’t wear helmets when the drive motorcycles. I don’t care to subsidize these choices through my tax and insurance dollars. I’d be delighted to see these self-destructive lifestyles disincented.
Obesity is a major burden on US society, and it is largely preventable. I would prefer not to have to subsidize preventable suffering. YMMV.
“Being fat *is* a choice for most Americans. That is simply a fact.”
That’s why they go on diets, isn’t it? Despite the fact that diets lower metabolism, engendering the yo-yo effect. What was the saying? “Americans have been dieting for forty years and are five pounds heavier.” Something like that.
Indeed. The science on obesity is nowhere near certain, and throwing around the “lifestyle choice” talk about it is a) ignorant, and b) sounds very much much like conservative “social problems as morality” kind of talk.
Obesity as we know it today did not exist prior to the 1800s and the advent of massive amounts of processed foods, cheap carbs and the lack of fresh veggies in our diets. I understand that some people are pre-disposed to being obese just as some are genetically wired to addictive habits. Our health care system can either treat all of us the same (single payer), charge risky patients differently or charge everyone more and more without helping drive down costs. The sad truth is that far more people are fat today than they were when I was a kid. Take a look at old school photos from the 60s and 70s. Kids were skinny back then. Today, most of those kids are fat and some are really, really fat.
Obesity, diabetes, etc. plus the kinds of obesity, a tripling for instance of peanut allegies every three years indicate to me something else is also going on.
You can track the dramatic rise of obesity to the 1980s. The ‘lifestyle’ explanation seems rarely applied to the context in which we live, as if indivduals are lacking but not the economic demands, corporate driven agendas, and such. Seems to me the punishment by wellness program avoids hard questions and conveniently asks us to target others.
Lest you think I absolve indivuals responsibility please know that I have seen some wellness programs work. No matter why health problems, there are at least some steps to be taken to avoid problems, but in a context of an economy driven by bad choices where does the gov and corporate responsilbilty lie as well??
Dan…I don’t know but if we let the markets determine what is healthy for us then we will continue to get fatter and fatter. Part of this problem is the consolidation of our food industry into giant ag firms that use the same ingredients in every brand making us think we have choice when in fact we are eating the same crap in different forms. If we will not address the food industry then it appears like we will have to rely on the health care industry to force people to think more about their food choices and habits. Ever been to Japan or France or Italy? Very few fat people…this is about culture as much as it is about legislation or health care.
I’m packing for two weeks on the road, so some quick anecdotal info.
Having morning coffee with Mrs. R., asked her professional opinion.
She tells me in her first 30 years of practice she remembers maybe three morbidly obese patients.
She has had three in the last two months.
She determines morbid obesity by two factors, interference with routine activities of daily living, and special clinical orders.
In other related news:
I did not know much about the topic until I bought “Good calories, bad calories”. Buy this book if you want to know the history of our knowledge about eating and the lack of real research on it. Much like the book on Cancer, this one will give you unbiased information on the state of our understanding. It is not a diet book.
Two ideas occur to me.
There is a clear tendency for people to take a single metric and wring all sorts of medical and moral correlations and causations from it. And then on to hiring decisions and bmi.
The medical aspects are not well understood. Some examples that are technical enough to demonstrate the difficulty of using such metrics.
Second, cultural is a tough concept….I agree it is very broad based, but what is it comprised of?, how was it molded in the last forty years?, and which parts can be addressed in what time frame?
I don;t see company plans being concerned with health at all, except as it affects a short term bottom line and usually means demand the individual bear the consequences.
Mrs Rusty is correct, and my own son has (also a medical person)….but we are talking why such an increase. I will look for the chart on weight gain for Americans since the 80’s/ Dramatic! But each of us individual responsible for the aggregate weight gain….nah.
I think culture has a role here in that our culture created a view of food production and choices based upon market forces rather than some long tradition of eating this or that food stuff. We also sat by while thousands of small farms were sold off to big ag along with all the supply chain which then created a new way of eating that was cheap, easy and not really that concerned with health. Try to get a Japanese person to stop eating rice or fish. Try to get a French person to stop shopping at the local markets…ain’t gonna happen. We allowed our entire food infrastructure to be sold to the highest bidder without any thought as to what we lost chasing profits, food production numbers and vertical integration. Since our previous culture did not really have food and eating as a predominant value system other than small pockets of regional eating habits, we became a nation fed by corporations, healed by corporations and managed by board rooms instead of small producers…that is how culture plays out IMHO>
no need to get nasty. i was expressing a feeling, not even an “opinion.”
but i think you and to less an extent Wooley are even more “conservative” than I am: you are terribly terribly worries that some people’s moral choices are going to cost you tax money.
and Wooley at least seems a bit inconsistent: he seems to understand the role of “culture” but he still wants the health system to “force” a change in behavior. seems to me it might be both more effective, and much less damaging to our cultural ideas of individual human freedom, to have the government, and the employers and the health plans, do what they can to encourage whatever “cultural” changes are needed to bring down the overall obesity rates.
i suspect that between “advertising” and “encouraging” the corporate food monster to go easier on the high fructose corn syrup this might be more effective than beating fat people until they reform.
maybe two other thoughts that i do not assert as “facts” much less articles of faith:
some people have metabolisms that do bettter on less food than others.
these people are especially prone to obesity (and diabetes) when living in a “culture” where excess calories are not only available but hard to avoid.
(two).. once the obesity pattern starts it may be hard or impossible to break the cycle. i don’t know, but from what i have seen “watch your diet” ends up futile to the point of cruelty for many who try it.
i would really hate to see these people become the victims of well meaning (moralist) behavior managers. reminds me, as i have said, of the maoist reeducation camps.
I am not advocating anything and certainly don’t think folks should be rated in a risk pool. I am merely stating options about how to solve a very complex problem in ways that other nations have done. Personally, I am for a single payer system. But we do have problems individually and collectively that cost us billions.
I think education and encouragement , not penalties, is the way to treat obesity in the US. After all, look at how well our drug problems have been solved with penalties.
What is the education when the educators are almost as ignorant as those they educate? The point is that we know little about the subject but we have as many theories/claims, as those that would make a penny off the plight of overweight people can invent.
I have no answers but I am amused at the real side of this issue. I think “charge them more” will become “they avoid medical help” and getting a skinny for the buck will fail. So again our for-profit system does not lead to health care for those who need it but rather profits for those who don’t. Or, perhaps the scenario will be that people a little overweight or morbid will not get employment so “we the people” will pick up the larger tab for the obesity while the obese person stays at home on disability and subsidy where he/she gets less exercise and eats more to relief the boredom and depression.
People are so smart about outsmarting themselves.
i have learned how to be healthy by avoiding all the doctor’s fads that have come my way for seventy years.
those wellness programs are likely to be nonsense at best… “tough love boot camps” at worst. well, maybe not worst.
i have a hard time getting worked up about some fat persons sitting home on the couch eating potato chips at “my” expense.
i would, if i knew how, encourage them to get out more (if they can) and have some real fun, and find better things to eat. they’d be surprised, i think, at what can replace potato chips and do-nuts… but here i am sliding into the “i can fix you” fallacy.
“collectively cost us billions” cost us individually “tens.” I hope we get our money’s worth. It would only take one serious illness or accident for us to get our ten dollars back. and i’d sure hate to have to answer “the commission” investigating whether my illness or accident was a result of some behavior excluded by my insurance policy, “properly interpreted.”
All I know is that I changed what I eat and lost 40 pounds. That’s all I did. I still eat all I want. I did not change the amount of exercise I get. I simply stopped eating some foods and started eating more of others. It is not a diet. It is a lifestyle change. I will eat like this forever. My weight is down. My blood pressure is down. My cholesterol is down. My health is up!
Perhaps the most interesting aspect of this will be when someone brings an Americans with Disabilities Act case arguing the administrative rules cannot trump the ADA statute.
Which side will Obama defend?
Mrs. R is having a bad day.
It is community festival day at the assisted living, a nice day for visitors and residents and a chance for young people to mingle with the oldsters.
Only problem being it is a cookie and candy festival, with cotton candy for dessert. Who can resist when a 4 year old hands you a cookie?
Mrs. R, being the fill-in director at the complex this week, will spend the evening getting emergency orders to prevent diabetic comas. Then she will come home and beat me to relieve the stress (ok, so that part is not true).
Family tip: if you have a loved one who has sugar problems, there are vendors of sugar free candy, rather than a box of Krispy Cremes.
you are no fun at all. a good husband would let his wife beat him to relieve her stress. lowers cholesterol too.
and as for Crispy-creme… no, that is just too cruel.
(but yes, i agree with you that cookies and cotton candy are not a good choice for people with weight problems or diabetes.. not even sugar free candy.
see, i am even more of a food nazi than you are. you don’t want to turn me loose. wellness program? hah! here’s a shovel.
absolutely. and while i’d add exercise to the list… if it’s something you want to do. (not something you “have” to do). even if it’s a job shoveling sawdust in a sawmill because you “want” to eat…
i wouldn’t try to force either of these on someone whose problem may be caused by something else entirely.. as you say “education” and “persuasion” they can take or leave according to their own lights.
i think we can still afford that much freedom in America.
A Blast from the past when LA refused a license for a fast food restaurant in one area.
Communities Have the Right to Plan and Zone
Rachel and Amaka:
Why does it have to be more fast food restaurants when there are already 400 saturating a 32 square mile area? Granted an ordinance is a rather crude way of accomplishing zoning to cut down on the proliferation of fast food restaurants.
“Jan Perry, a Los Angeles city-council member, is spearheading legislation that would ban new fast-food restaurants like McDonald’s and KFC from opening in a 32-square-mile chunk of the city, including her district. The targeted area is already home to some 400 fast-food restaurants, she says, possibly contributing to high obesity rates there — 30% of adults, compared with about 21% in the rest of the city. Nationally, 25.6% of adults are obese, according to the Centers for Disease Control and Prevention.” http://online.wsj.com/public/article/SB121668254978871827.html “Exiling ‘The Happy Meal’”
400 “fat and fast” drive-thrus, walk-ups, and carts or ~ 12 per square mile, or 1 per an ~ 2.4 million square feet, or 1 per 1250 people. Anyone still think we are stomping on the rights of people to get their “hot and greasy” when so many exist already? Think any of those fast food places are providing healthcare insurance to their workers as they delve out and into those chunks of fat.
The preferred way of minimizing an overwhelming abundance of one type of business is to develop a master plan for that area and zone it accordingly with the appropriate restrictions. No community wants all super stores, all fast food, all cleaners, etc. because the fallout is closed store fronts which create other issues. Master Planning and Zoning is the preferred method of planning for a community and if done appropriately it is not a “takings” as long as it is the same as or above the last zoning. One methodology to use for this area is Transit Oriented Developments (TODS) or Mixed Village Use. In each situation, a plan is developed that gives a vision to the developer of what the City Planning Commission would like to see there . . . such as parks, single family homes, apartments, senior housing, neighborhood grocery, offices, drug stores, senior center, community center, etc. It requires a little more forethought than just throwing an ordinance at it.
As a member of a Community Planning Commission in a suburban township that is bigger than 32 square miles, we have 6 fast food restaurants split between two intersections and feeding ~16,000 people and commuters. They are always full at an ~ 2600 people per restaurant. So what is the beef about saying “no” to more fast food restaurants in one section of LA when the average is 1,250 people per fast food restaurant? We too have decided we have enough fast food restaurants and have also said no to super stores, gasoline stations, etc. The thoughts the both of you are conveying here sound like a throwback to the fifties and sixties when there were multiple gasoline stations at intersections just blocks apart. Why add more restaurants here, when it already exists?
William Saletan talked about apartheid and you two are talking discrimination. All three of you missed the clarity of the argument when you start to examine the numbers of fast food restaurants already there. You really should have better points to bring to the fast food counter or drive thru window such as an ordinance is not the way to go as it lacks clarity and does not provide a vision. With a good master plan and appropriate zoning, the city can attract the right developer and stores to the area. Chicago redeveloped many of its older sections and still is with appropriate planning. Rachel’s extreme example of “Whole Foods” being too expensive is silly at best. Tell us something we didn’t know already? Maybe encourage some farmer’s markets? The thrust should be to develop the area as a community that is transit- oriented and people can walk; thereby minimizing the energy costs for people, a better environment, creating a community that will add to the city.
Obesity should not have ever entered the discussion of too many fast food restaurants as the numbers are enough to quash any argument of adding more to that area. While Jan does have a point with the obesity argument and the apparent linkage, she should not have entered that arena. More on obesity:
In a 2004 U.S Department of Health study, “The High Concentration of U.S. Healthcare Expenditures;” the study goes on to list 15 different disorders that account for 44% of all healthcare expenditures in 1996, 5 of which (heart disease, cancer, trauma, mental disorders, and pulmonary conditions ) were the most expensive to treat in 2002. Looking at the 5 disorders, can anyone deny there can be a link between diet and heart disease or cancer? Or that 25% of the population suffers from multiples of the study goes on to cite:
“For 16 of the 20 most expensive conditions, the rise in the number of people being treated accounted for more than half the growth in private insurance health care spending. Researchers attribute the additional numbers of people being treated to three factors:
• The continued rise in the share of privately insured adults classified as obese.
• Changes in clinical treatment guidelines and standards for treating patients without symptoms or with mild symptoms only.
• The availability of new medical technologies to diagnose and treat patients.
Especially important is the increase in the number of people treated for conditions clinically linked to obesity. From 1987 to 2002, the proportion of the population treated increased 64 percent for diabetes (accounting for 80 percent of the increase in costs) and increased 500 percent for hyperlipidemia (accounting for almost 90 percent of the increase in costs). A number of factors might explain the substantial increase in treatment rates for conditions linked to obesity. These factors include a rise in the number of people with obesity-related conditions, a rise in the number of more seriously ill patients, a greater emphasis on preventive care, and the introduction of broader treatment options.”
As recent as the passage of the caloric intake posting in NY, the restaurant association executive vice president made this statement:
” ‘They have absolutely no scientific backup for any of their claims,’ says Chuck Hunt, executive vice president of the New York State Restaurant Association,”
No scientific claims about the links between eating too much, obesity, and disorders? We have not even touched upon children and their sedentary life styles coupled to fast food eating or the plight of the poor and those in poverty who are uninsured. Still think fast food does not impact this? Healthcare and healthcare insurance costs are the biggest issues facing the US economy today and it surpasses the “alleged” bankruptcy of Social Security. 40 million people will walk around without healthcare insurance or a loss of healthcare insurance during some portion of the year. We are clamoring for government intervention granting healthcare for all people without the very same people lifting one finger to change their lifestyles all based upon the individual’s right to freedom of choice. Does it seem reasonable for the government to intervene and pay for healthcare insurance and/or healthcare costs without requiring something in return to lower healthcare cost and the risk of poor health?
Perhaps, the way to get people to modify poor eating and lifestyle habits is to educate people and hit them in their pocketbooks? The same as higher gasoline prices forcing fewer car trips and slower driving to conserve on gasoline, it may be that same impetus needed to force the issue of improving lifestyle for those that can do such. There is a direct link between food and obesity caused disorders, the same as cigarettes and cancer. Perhaps, a tax can be placed on fatty foods of higher calorie count. A tax that could go into a fund to treat those people who wish a non-healthy lifestyle and at least then a greater portion of the cost could be picked up by those who wish to indulge. Fast fatty foods should not be cheap.
The one issue I have not touched upon is that of those living in poverty or are poor as defined by this administration as being 250% of the poverty limit. In many of the neighborhoods, the availability of fresh foods with low fat and sodium content is somewhat limited as suggested by 400 fast food restaurants whose prime mission to sell the whopper, the classic, or the big mac. Many heads households are single women who find little time to be cooking fresh meals as much of their time is spent working to make a living. It is often times cheaper and easier to turn to fast foods to feed a family. So why not more nutritious and lower fat menus at fast food restaurants? http://fray.slate.com/discuss/forums/post/1578245.aspx
“The science on obesity is nowhere near certain, and throwing around the “lifestyle choice” talk about it is a) ignorant, and b) sounds very much much like conservative “social problems as morality” kind of talk.”
Uh, no. The science on obesity is clear. If I bet a dollar that every obese person is or will become diabetic in their lifetime, I would win more money than I would lose. If I bet a dollar that every obese person will die of a heart attack or cancer before age 65, I’d win more money than I would lose. Those bets would be based on the science of obesity. Read about it and learn.