Paying Our Way to Better Health?

The state of North Carolina announced recently that it was considering a change to how much its employees will pay for health insurance premiums, and the potential change has caused quite an outcry. The basic problem with the state employees' health insurance plan is that it's losing money, and the primary reason is that it is insuring too many sick employees. The costs are high enough that younger, healthy employees can often find cheaper insurance for themselves and their dependents by opting for private insurance.

The solution, according to the state: charge higher premiums for those employees who are smokers and those who are overweight. Not surprisingly, the suggestion met with almost immediate opposition. How could the state know which employees smoke on their own time? And how would they determine if an employee was overweight, without raising enormous privacy concerns? I'll leave the debate about insurance costs for smokers for others, but I am curious about the notion of making people pay more for insurance because they weigh too much.

Obviously, I've had my own struggles with my weight, and my bias would generally be in sympathy with the overweight. It is an interesting conundrum, though. The reality is that for the most part, people who weigh more also have more health problems, including issues like diabetes, heart disease, and breathing problems. Those health issues often translate into higher health costs, so the insurance companies and those who provide insurance (both government agencies and private employers) have a vested interest in how the health of their employees translates to the bottom line. At the same time, it's hard to avoid the sense that people are being punished for something that may or may not be within their control. In this particular case, the standard for being "overweight" which would trigger higher premiums equated to weighing 35% more than normal (and I recognize that "normal" can be difficult to define). The state would also provide a method of exemption for those who are medically unable to lose weight. Still, it does raise the specter of a clash between our public and private lives, where our employers would be interested in the number on the scale, and would be able to, in essence, reach into our pocketbooks to make us pay the price for our unhealthy choices.

And that right there is the main issue, as far as I'm concerned. What is the right approach to encourage people to strive for a healthy, active lifestyle? It seems to me like this is basically a "stick" approach; in other words, punishing people for not eating good things or being physically fit by making them pay more money for health insurance. But I have to wonder whether a "carrot" approach might be more helpful. I'm not sure if I want to advocate for paying people for good behavior. But I also might be more motivated to lose weight if I knew that doing so meant a financial payoff in the form of perhaps a cash bonus or a rebate on my health care expenses. Maybe that's greedy or mercenary of me, but I'd prefer to think of it as being practical. If there's a tangible benefit to staying on the straight and narrow when it comes to eating healthy - money, in this case - then I'm much more likely to stick with it. The end result is the same: I'm healthier and don't need to visit the doctor as often, and that's what will make me and my health insurance provider happier - and maybe even for some of the same reasons.