Health Insurance: Health Based Charges?

It looks like one company is evaluating charging unhealthy people more for health insurance (slashdot):

Joe The Dragon sends us a BusinessWeek story, run on Yahoo, about Clarian Health and the new thing they are trying with health insurance coverage for their employees. They are charging unhealthy people more. The article goes into some depth about whether this is a good idea and whether the practice might spread. “In late June, the Indianapolis-based hospital system announced that starting in 2009, it will fine employees $10 per paycheck if their body mass index (BMI, a ratio of height to weight that measures body fat) is over 30. If their cholesterol, blood pressure, and glucose levels are too high, they’ll be charged $5 for each standard they don’t meet. Ditto if they smoke: Starting next year, they’ll be charged another $5 in each check.”

A positive reaction is understandable (smokers and unhealthy people should be charged more!).  But this is a dangerous development for a two reasons:

  • Impact
  • Slippery Slope

Impact

By charging people more for fat, suddenly pressure on all food suppliers (not just fast food) will change drastically.  Using high fructose corn syrup (which is in nearly everything) will become a much more contentious issue.  Lawsuits for providing unhealthy ingredients will increase.  Maybe this isn’t a bad thing, but it is something that needs to be taken into account.

Slippery Slope

This is where the crux of the problem lies.  Make no mistake, its ethics sliding down this slope.  For example, what about people who are genetically predisposed to higher bmi’s?  Is it right to charge some people extra for a condition they were born with?  Why stop there?  If the reasoning is unhealthy people cost the system more, why not charge people extra with a genetic predisposition to heart disease or cancer?

Why not structure health insurance like car insurance:  if you get sick, your premiums go up?

After all the goal is to reduce costs, and that is a surefire way to do so.

While it seems like this is a neat, innovative idea, it is just the first step towards a profoundly unbalanced approach to health care.  It is one that comes naturally from a system that obsesses over keeping costs down, and puts the actual health of the people in its care second.

The battle over health care is a battle over a single question:  whose health matters.

Clarian Health is taking us another step away from the ethical answer.

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