Monday, October 26, 2009

Fat fairness (updated)

Fat rights lobbiests argue for fairness in pricing. By their logic car companies should sell obese people SUVs at a discount.

Is it enough to argue that you can't tell whether obesity is a pre-existing condition therefore it's not fair to charge the obese more for health insurance?

You can't tell whether my lack of productivity is due to a pre-existing condition. Pay me the same as everyone else. (Yes, I'm just kidding.)

Addendum added Oct 27. I've stumbled on this written on October 26th by the health economist Uwe E. Reinhardt:
It sounds like a great idea until one thinks about exactly how such an idea would be implemented in practice – especially in a country with a tort system such as ours. I wish both had given us their thoughts on that problem.

To take account of smoking in setting premiums is easy. Life insurers already do it, and even under community rating within mandated health insurance it would be relatively easy to charge higher premiums to smokers. I would favor it.

But consider obesity. Presumably an insurance company would somehow ascertain an applicant’s biomass and then somehow determine how much of any overweight is due to avoidable unhealthy behavior, and how much is rooted in genetic factors.
And even if that could be easily and cheaply done in practice, before long tort lawyers would bring class-action suits, citing the growing body of scientific literature suggesting that many behavior patterns — including unhealthy lifestyles — are rooted in very early cognitive development and subsequent education....
Add to that list environment factors beyond the individual's control, such as access to nearby grocery stores selling healthy foods at prices comparable to those in richer neighborhoods. See my essay at Daily Episcopalian.

Addendum 2, Oct 30. The technology could exist soon for your mobile phone to send your insurer information about your eating and exercise habits. Insurers could offer two kinds of policies, one where you consent to being monitored and another where you do not. Those who do not reveal themselves to be prone to unhealthy habits and would pay more. The insurer in this case is not insisting you reveal. They are only giving you the opportunity to reveal.

Oh, and isn't Reinhardt caught in an inconsistency between approving of charging higher premiums for smokers and not for those who have bad eating behavior? Arguably you can't help it that you like tobacco either. You may think, oh, but we know tobacco is bad for you and society frowns on it. But we're coming to that point with food abuse, too. Eat all you want, just don't base my premiums on how much you eat.



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