Shape Up or Pay Up

Continuing the reporting trend on weight and obesity, the LA Times is reporting that workers at an Indiana based hospital chain will be charged upwards of $30 every two weeks unless they are within blood pressure, weight, and cholesterol ranges that the company deems healthy.

While this is targeting more than just those who are obese - Clarian Health Partners are determining weight based on a BMI of 29.9 or greater - it's pretty likely that the majority of interest in this will focus on people who are heavier being penalized for being heavier, and not those who have a normal BMI but high cholesterol or blood pressure.

The article also discusses financial incentives being used by various companies, from the Los Angeles school districts to other health care insurers, that "reward" people for healthy lifestyles/behaviour by reducing their deductibles. For example, the UnitedHealthcare plan has a $5000 yearly (family) deductible that can be reduced to $1000 if the employee isn't obese and doesn't smoke.

Obviously these incentive programs cover a lot of ground - weight, smoking, blood pressure, cholesterol, etc. The question becomes - is this right? Is this the appropriate way to deal with spiraling out of control health costs? Should people be penalized for not being in good health? And is refusing to hire people because of their BMI the next logical step, after refusing to hire people who smoke?

Smoking is an addiction, and one that we know can be broken with effort and encouragement. But should obesity, high blood pressure, and high cholesterol - things that can be genetic - be looked at with the same light? Should you have to pay $60 a month because your father gave you his high cholesterol? Should you have a higher insurance deductible because you have a chronic health condition that leaves you unable to exercise as much as others, thus pushing your BMI higher than it should be?

Perhaps most troubling, though, is the simple fact that the "solution" to our growing health coverage crisis is to pass the cost along to the individual employee, who may or may not have direct control over the issue they are being financially penalized for.