But increasing premiums for the obese does not mean a return to a Henry Ford-style regime; it would simply mean acknowledging the double standard that exists in the present health care system: Smokers, for example, have been paying higher premiums for their vice for years. And some individuals, as a matter of routine, are summarily denied health insurance coverage for any number of things, from arthritis to old sports injuries to abnormal heartbeats. Even those who are insured through employers’ group plans aren’t necessarily covered for “preexisting conditions”—including those over which they have no control, such as asthma or even cancer. So why not obesity? After all, it’s on the verge of replacing smoking as the leading cause of preventable death, according to the National Center for Chronic Disease Prevention and Health Promotion.
Coming to terms with what is essentially a fat tax isn’t easy. It requires a shift in how one thinks about health insurance. While I personally believe in basic coverage for everyone—fat, feeble or otherwise—that’s not the reality of our health care system. Many insurers are for-profit businesses that are about risk and the bottom line—in America, health insurance is a privilege, not a guarantee.
Actually, it’s not all that different from auto insurance, a system in which we accept all kinds of discrimination: If you’re a man, you may pay more. If you choose to buy a souped-up sports car, you will pay more. If you rack up speeding tickets, your rates will ratchet up as well. Choosing risky lifestyle behaviors—be it sucking up cigarettes or supersized meals—is basically the health insurance equivalent. The difference is that in auto insurance, you might also get a safe driver discount if you don’t have any accidents. So where’s my skinny discount?
Turns out, some places already have one. Starting in 2006, county employees in Benton County, Arkansas, were able to reduce their deductible from $2,500 to $500 by keeping a low BMI and taking yearly physicals. And Regence BlueCross BlueShield of Oregon, the state’s largest health insurer, began offering a new plan in October, Vitality, that encourages employees to keep fit by rewarding those who work out and eat healthy with gift certificates to places like Borders and Target. These incentivized health programs seem to be successful at reducing health care costs: A Journal of Occupational and Environmental Medicine study reports that one company with an incentive program, GlaxoSmithKline, saved roughly $5.5 million dollars in health care costs over a four-year period.
Practically, these kinds of wellness programs are the same thing as a fat tax; they’re just more diplomatic. But maybe a semantic shift is all that’s really necessary to make the bitter pill go down. I pitched the theory to my mom, hoping she wouldn’t disown me.
“If you told me I had to pay more for my health insurance because I’m overweight, yeah, I’d be angry, even though being heavy is largely my choice,” she said. “But when you put it like that, it somehow seems better. I suppose it’s all just a matter of perception.”
“So,” I pressed in an e-mail, “you won’t write me out of the will for suggesting this?”
“No,” she responded. “We’ll just use your inheritance to pay our premiums.”