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Your BMI is 35: Should You Pay More For Healthcare?

My son had a baseball tournament this weekend.  On both Saturday and Sunday, I made the choice to go to a park and get a run in while all the other folks packed up and went to lunch between games.  I still got something to eat, I just decided to use the time to get some exercise while there was maximum supervision (read: free babysitting) around to watch the kids.

I didn't really want to get the run in.  I still did.  My point?  I tried.  Once it's done, they can't take it Bmi-calculator away from you.  Whether I'm 170 pounds or 270, the fact that I got some exercise and do it consistently (run/walk - who cares?  Just get the heart rate up) matters.

Here's why it's on my mind.  It really doesn't matter who owns healthcare - employers or the government - because the issue is the same.  Most of the healthcare issues we face as a country are self-inflicted.  Check out this line of thought and stats from a recent column by Geoff Colvin at Fortune:

"At the beginning of the 20th century, the top causes of death in the US were communicable diseases - flu, tuberculosis - curses that could strike any of us.  Today, the top causes are mostly the result of the way we live - coronary artery disease, hypertension, diabetes and some cancers.  We spend 50% of our health care costs on diseases caused mostly by the way we behave.

If Americans behaved just a little differently, our health care costs could settle down to the sustainable growth rate that matches the economic growth.  We don't need a nation of triathletes.  We just need to smoke and drink less, walk a little more, eat a few more vegatables and lose some weight.  More than 90% of Type 2 diabetes, 80% of coronary artery disease, 70% of stroke, and 70% of colon cancer are potentially preventable by that combination of moderate behavior changes, reports Harvard epidemiologist Walter Willett."

My friend Dawn Burke had a post up recently on Fistful of Talent called "This HR Fatty wants to give someone a fat lip", where she rightfully blasts a company's announced decision not to hire anyone over a BMI of 35. 

I agree with her - that's stupid.  Lots of very talented people have weight problems, and if you start eliminating those people from working for your company with an imperfect measure like BMI, you've played yourself.

But - based on the data above, which is certainly accurate, why should everyone pay the same for healthcare?  Why is that a right?  More from Colvin:

"Why don't we act healthier?  Part of it is economic - we bear ever less of the costs of our unhealthy behavior.  In 1960 we paid 56% of our personal health care costs out of our own pockets, in 2010 we paid 14%."

You're kidding me, right?  No wonder people don't care.  

I'm not saying that only people who are thin deserve a right to pay less for heathcare, I'm saying that people who try ought to pay less.  You've got a BMI of 35+ but there's an improving trend in all the wellness stats (blood pressure, blood glucose, resting heart rate - help me out here wellness types...)?  You should pay less, regardless of your BMI, or what the world thinks about how you look.  You're controlling what you can, perhaps within a god-given genetic profile.  

But... You're very overweight and don't even TRY to talk care of yourself?  The same wellness stats point to a 5-year trend that indicates you've got a high probability of exploding on Thursday?  Why wouldn't you pay more?

I don't get it.  It's a basic accountability factor, and we won't reverse the trend related to healthcare costs until people who don't try (and then end up high risk) have to pay more.  Lots more.

And that issue is the same whether ObamaCare becomes a reality - or not.

Comments

Tim Gardner

Chris-
I once heard a speaker say that it takes real committment to have a heart attack. Our bodies are robust enough that you have to continually abuse them over time before the attack happens.
This is so right - small adjustments, continually applied, can keep us from killing ourselves. Yep, we all die eventually, but we can keep it from being a result of numerous poor choices.

Lruettimann

I think it's BS that the government subsidies sugar and corn -- and gives all kinds of breaks to Monsanto -- and then asks other businesses to bear the brunt of a busted US food policy.

If the government actually had to pay for healthcare, our "food pyramid" would look a lot different and we might actually have real wellness in this country. As a nation, we couldn't afford to drink Double Diet Dew and eat Oreos for breakfast. But when we bake in the cost of healthcare into the private sector, the government can ignore its failed corporatist policies.

Yes, I'm both anti-govt and anti-corporate.

And I vote.

Paul Hebert

Can you say "tragedy of the commons?"

The most salient point in this post is:

"Why don't we act healthier? Part of it is economic - we bear ever less of the costs of our unhealthy behavior. In 1960 we paid 56% of our personal health care costs out of our own pockets, in 2010 we paid 14%."

When a resource is free it is overused. Healthcare is an individual problem we are trying to solve with a common system.

Socialized costs - privatized gains.

Gains=Cheeseburgers Costs=Angioplasty

Pat

Ah. I love statistics. Mind you, i was just surfing and came across this article. I have done no research whatsoever, but two things immediately jumped out at me. 1. Maybe the reason more people are dying from self induced illnesses is that because much fewer are dying of TB and influenza. Thank vaccinations and antibiotics for that one. And 2) We are paying a smaller portion of health care because the costs of health care has risen dramatically. How much was that 56% back then in dollars, and how much is the 14% in dollars today?

Jim Winkler

We call this thought process " house money, house rules." you want to spend the house's healthcare dollars, you have to comply with the house rules, we want the person with the BMI of 35 to work at getting it to 33, and then to 31, and so on. And if they take the steps to do that, the benefit plan should feel good. And for the person who has a BMI of 28 but does nothing should find the benefits plan expensive and narrow.

PB

hmmm. given that places like Canada and the UK have national health services AND a fitter population,I'm not sure your argument stands against the evidence.

Karin

Canada does have a national Health System, and taxation and premiums are the revenue sources to pay for this. In other words, citizens are still paying for health care -the money just gets gathered differently. A few decades ago, as the realization that more people lived longer and more people live in the country meant the overall cost of maintaining National Health would also increase. Add to that advances in technology and medical research and the $$ factor was clearly becoming a huge component of the budget.

There is many misconceptions about how, when and why people develop health issues, many of them driven by initial studies that are published, usually with the words (might, may be, possibly) somewhere in the conclusions. It is also driven by looking at stats from one perspective and excluding data that may not support the conclusion we want. Humans also like to feel they have some control over what happens to us and believing that if we just eat a certain way, exercise enough and correctly and reduce stress that we can prevent or avoid many health problems. And we sorta, kinda, maybe can. Or not. Because genetic research also indicates that regardless of how health oriented your behaviour is you can, for genetic reasons, still get diabetes, heart disease, cancer, etc. So, sure it is still a good idea to practice positive health behaviours-it is also a good idea not to be too quick to judge, blame and point fingers as those that develop health problems-because some day-that could be you.

So what does this Canadian think about the cost/behaviour concept? As a motivational factor,it might be somewhat effective for extrinsically motivated people that also have a strong connection to $$ as motivation. So what is going to motivate the rest of the population?

KN

Generally, I agree that everyone should be working toward being as heaLthy as possible. A few points, though:

In this more-with-less work culture, it is much harder to find the time to exercise and cook. In the 1960s most people worked 8-hour days, not the 10-12 we do now, and they weren't expected to be reachable 24/7. If I'm at work at 8 PM, what do I have for dinner? Junk out of the vending machine.

KN

(rest of post, got cut off)

If this article were on working parents rather than BMI, skipping lunch with your child to go run might be seen as a negative rather than a positive. Not judging, just saying everything is a tradeoff.

Insured workers don't have the information to be responsible consumers of health care - Try getting the "reasonable and customary" rate for a treatment from your insurer, so you can shop for a provider who charges that rate or lower. they won't tell you.

Eve Stranz

A number of companies offer reduced healthcare premiums to employees who participate in a health & wellness initiative or program. It doesn't matter what your BMI is, but you may need to undergo a biometric screening and well being assessment (which remains confidential, but increases your awareness of your personal health and where you should focus.) One example of this type of program is Virgin Health Miles.

The bigger question is...how many adjacencies did it take for Richard Branson to grow his organization from a record company to one including a preventive healthcare program?

Ben

Amazing ideas to ponder and practice. Thanks.

Lokman Hossen

Daily 30 minutes exercise may save your money after 35.. thanks for share

ndemi

I never understand this BMI thing.

Martin Buuri Kaburia

Its always important to take care of one's health

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