Obesity Summit

[mr_gyptian]

This is fucking hilarious. This guy's got an idea, they already drill smokers with exceedingly higher health insurance rates.

The Barriers Don't Exist

By Radley Balko Published 06/04/2004


Editor's note: This is Radley Balko's third installment reporting from the obesity summit in Williamsburg, Va. Read his first two installments here (installment 1) and here (installment 2).


When I was originally asked to write the designated dissent piece for TIME's special issue on obesity, I went back and forth with a fact-checker over my assertion that state and federal governments prevented health insurers from tying health insurance premiums to risk -- the same way car and life insurers do. Charging everyone within a group plan the same amount for health insurance removes an important financial incentive to stay healthy, and forces fit people to subsidize health care for the not-so-fit. Allowing folks who keep the weight off and the blood pressure and cholesterol down to pay less for health insurance (and allowing health insurers to provide it to them) would also strike a needed blow for personal responsibility in the obesity debate.



The problem is that though several health care policy experts told me they were certain health insurers were barred from such "medical underwriting," no one could say exactly why. In fact, I talked to several health insurance companies themselves, and none could point to any specific law, regulation, or case law laying out the prohibition. I even called tort king John Banzhaf, who -- believe it or not -- is actually on record supporting lower premiums for fit health care consumes, though only as it applies to obesity and blood pressure.



Banzhaf told me the bar stems from a mid-1980s ruling by the Department of Health and Human Services at the request of health insurance commissioners. The commissioners had asked HHS to allow higher premiums for smokers, overweight and obese people, and those who don't take basic steps to reduce high blood pressure. HHS, Banzhaf said, okayed the smoking provisions, but balked on obesity and blood pressure.



The problem is that I couldn't find any independent confirmation of Banzhaf's explanation.



That in mind, I sought out and got a few minutes to speak with HHS Secretary Tommy Thompson after he spoke to the Obesity Summit on Wednesday evening.



"Do you know why it is that health insurers can't charge lower premiums to reward people who stay fit?" I asked.



"No," Thompson said. "I absolutely support the idea. I think they should do it."



"There's no law preventing it?"



"Not that I'm aware of. We'd heard there might be something preventing it when I first took office. But I had my counsel's office look into it, and we don't see any reason why they can't do it. And we think they should."



On Thursday, there was a panel here in Williamsburg called "The Shift Toward Prevention." One of the panelists was Dr. William Popik, the Chief Medical Officer for Aetna, Inc. Aetna has just launched an interesting new anti-obesity program for the people it insures, featuring counseling and nutrition advice. On the panel, however, Popik mentioned that the health insurance industry may, someday, give discounts on group plans to corporations that adopt and implement fitness and anti-obesity programs, but that "we're a couple of years away from that." He explained that because America is still primarily a third-party-pays system, we won't be ready for carrot-and-stick health insurance until we move more toward a consumer-driven system, where we as individuals begin to see just how much health care costs.



After the panel, I asked Popik why Aetna and other insurers hadn't even considered moving beyond corporate incentives, and moved toward individual incentives. That is, charging individuals different premiums -- even within group plans -- based on risk.



"Because it's illegal," he said.



I told him about my conversation with Secretary Thompson.



"That's very interesting," he said. "Our lawyers have told us it's not legal. If HHS says otherwise, maybe our people need to call the people at HHS."



There seems to be a serious disconnect between actual health care policy and the advice the health insurers are getting from their legal teams.



After my conversation with Popike, I called the general counsel's office at HHS. Deputy General Counsel Paula Stannard walked me through every possible federal barrier to medical underwriting, and explained why they don't apply.



In fact, in 2001 the Depts. of HHS, Labor and the Treasury (in predictable federal bureaucratic confusion, the three agencies share jurisdiction over the issue) proposed a regulation (66 Fed. Reg. 1421) insisting that the convoluted HIPAA (Health Insurance Portability and Accountability Act) regulations be interpreted to allow health insurance companies to underwrite risks.



In fact, Stannard said that Title III of the Americans with Disabilities Act (ADA), the section addressing public accommodations, explicitly allows health insurers to make distinctions in writing premiums, exempting them from the ADA's purview. And an Equal Employment Opportunity Council (EEOC) interim guidance issued in 1993 says the ADA isn't applicable to employer-provided health insurance.



Stannard added that despite what you hear about outrageous ADA lawsuits, the relevant case law has not included obesity among ADA-protected disabilities.



So HHS, the EEOC, the Departments of Labor and Treasury, and the courts have all said our health insurers should be free to assign risk in the same manner car and life insurers do.



Yet the health insurers, for whatever reason, still seem to think they can't.



There of course may be barriers at the state level. But leadership at the federal level (I'd recommend via the bully pulpit, not through superseding federal law or regulation) might convince those states that would bar medical underwriting to change their minds. Another way around state barriers would be to introduce federal legislation allowing residents of any individual state to purchase health insurance in a state with a regulatory scheme more to their liking.



The important point here is that it's time we tailored health insurance to health risk, just as we do with every other variety of insurance. Health insurance companies have been reluctant to do so due to perceived barriers from the federal government. Those barriers don't exist.



We can make strides toward better health by allowing the free market to incentivize the kind of lifestyle that brings it.



Copyright © 2004 Tech Central Station - www.techcentralstation.com

[The AD]

Maybe the real reason is the insurance companies don't want to piss off fat people. With obseity on the rise who wants to be the first insurance company to charge more for premiums for fatsoes? They might lose market share right away that they'd never make up even when other companies followed suit.

Just a thought, anyway.

[stump832]

obesity summit? how come i wasn't invited?

[mr_gyptian]

Originally posted by stump832
obesity summit? how come i wasn't invited?

I'm sure there's some fine hogging to be had.

[The AD]

Originally posted by mr_gyptian
I'm sure there's some fine hogging to be had.

None of the fat people actually showed up, though. They were worried "summit" implied they'd have to climb something.

[Telenater]

And, of course, how would they make the determination about who's obese? If they make everybody go into the doc to be tested that'll cost them a bunch right off the bat.

And what is the definition of "obese" going to be? Body fat, ht vs wt, BMI?

[stump832]

Originally posted by mr_gyptian
I'm sure there's some fine hogging to be had.

are you implying i'm easy?

[mr_gyptian]

Originally posted by stump832
are you implying i'm easy?

no, the big fat fatty's.

[danimal's dead]

Didn't we have a thread on the old powder board about some plus size hoggin' convention, that I think was held in Atlanta, where big girls wear revealing lingerie and have swingin singles parties at various bars and hotels throughout the weekend.

[stump832]

Originally posted by mr_gyptian
no, the big fat fatty's.

That was close. Almost ran to the cupboard to eat away the pain and shame.

[Viva]

Originally posted by Telenater
And what is the definition of "obese" going to be? Body fat, ht vs wt, BMI?

For men, BMI > 25

For women, > 30

[The AD]

Originally posted by Viva
For men, BMI > 25

For women, > 30

Why is that? Because men are more likely to suffer health problems from being overweight than women? >25 is only considered overweight, not obese. For example. 25 for a 6' tall man is 184 lbs. Who would consider that obese?

Now a BMI of 30 for a 5'6" woman is 180 lbs. Yeah, most people would consider that obese.

[Telenater]

Originally posted by Viva
For men, BMI > 25

For women, > 30

That's what I was afraid of. Using just the BMI for defining obesity will screw a large number of relatively healthy people (Like me).

[mr_gyptian]

Weighted average of the three???

[splat]

Originally posted by mr_gyptian
Weighted average of the three???

Alex:

"Weighted average of the three. That is the correct answer to the question, 'How does one compute the amount of fat pressed while attending an orgy at the Obesity Summit?'"

[Benny Profane]

One of my favorite topics. I truely believe that this is America's biggest problem, simmering just below the boiling point, as it's tied into our financial situation, both as a nation and as individuals. Soon, the millions of fat, no exercise boomers will be falling ill due to theur lack of personal care, and will severely strain the medical insurance systems, both public and private. They won't have any money, because they didn't save a dime, and are probably in some severe debt situation, and the country, as we know, will be maxed out on it's credit, so forget about medicaid or medicare. So the healthy people will be taxed to the max to pay for these turds gobbling down overpriced drugs as they are hooked to some sort of expensive machinery, keeping them alive for another ten years. I say invest in drug and hospital corporations to get the upside.

[Viva]

You're right. Overweight is defined as having a BMI > 25 and obese is having a BMI > 30, although these standards are somewhat relative.

[Viva]

Originally posted by Benny Profane
Soon, the millions of fat, no exercise boomers will be falling ill due to theur lack of personal care, and will severely strain the medical insurance systems, both public and private.

It's easy to atttribute obesity to sloth and, to an extent, this is so. But it is also very possible that many of these people became predisposed to obesity either in utero or postnatally- i/e., blame the parent(s).

[Cosmic Bandito]

The film (I won't call it a documentary for fear of incurring the wrath of Mr_Gyptian) "SuperSize Me" details how stacked that cards are against Americans to stay thin.

While you can argue that we should all get off our duffers and eat healthy meals, it is quite apparent that portions are too large, high fructose drinks are too prevelant and poor dietary habits too ingrained in our society to think that slimming down will be anything but easy.

Sweet Jeebus, people get their stomachs reduced to the size of a baseball to lose weight. If that isn't desperation, I don't know what is.

[AntiSoCalSkier]

Defining obesity is really tought to do though. We all know the difference between a fat guy and one of those "World's Strongest Man" competitors when we see them, but on paper it's hard to tell the difference. Someone who is 6'0" and 250 lbs could either be a fat guy, or just a really big guy. Would body fat percentage work? Or maybe you could come up with some sort of composite number based on a bunch of factors (mile run, bench press, resting heart rate, etc).

[Benny Profane]

Originally posted by Cosmic Bandito


poor dietary habits too ingrained in our society to think that slimming down will be anything but easy.

You see, this is the problem. It is easy. Real fucking easy and simple. Eat less, eat healthy, and exercise. That is it. Cheap, too. It's your body, your problem. Don't come whining to me when you can't get up out of bed or they start chopping you feet off because your blood decided to stop flowing.

[divegirl]

Originally posted by Benny Profane
You see, this is the problem. It is easy. Real fucking easy and simple. Eat less, eat healthy, and exercise. That is it. Cheap, too. It's your body, your problem. Don't come whining to me when you can't get up out of bed or they start chopping you feet off because your blood decided to stop flowing.

He has a point. And even though I'm not a skinny mini, I agree 100%. I was a fat kid. In second grade, my mom took me to a dietitian and our whole family started eating less and more healthy foods, and exercised more. By the 4th grade I looked like a stick. So, the moral is, if parents would get off their asses and learn to eat right, obesity won't be a problem.

[Will]

Originally posted by Viva
It's easy to atttribute obesity to sloth and, to an extent, this is so. But it is also very possible that many of these people became predisposed to obesity either in utero or postnatally- i/e., blame the parent(s).

[Curious]
Anyone have any actual numbers on how many obese people are actually genetically predisposed to be obese? I mean, it's a lovely excuse and I'm sure that it applies to the leaders of those "fat rights" groups - but does it apply to every fat person? Most of them? Many of them? Very few?

And how strong of an influence is that predisposition; is it impossible for them to get healthy, very hard, hard, or just difficult?

To what extent is our weight a life-style choice?[/Curious]

------

Also, it does occur to me that smoking is considered a reversible lifestyle choice even though folks are physically addicted to cigarettes, and started the habit when quite young or before the negative health consequences were understood. The difficulty of quitting smoking is not considered an excuse.

[The AD]

Originally posted by AntiSoCalSkier
Defining obesity is really tought to do though. We all know the difference between a fat guy and one of those "World's Strongest Man" competitors when we see them, but on paper it's hard to tell the difference. Someone who is 6'0" and 250 lbs could either be a fat guy, or just a really big guy. Would body fat percentage work? Or maybe you could come up with some sort of composite number based on a bunch of factors (mile run, bench press, resting heart rate, etc).

But are you really certain these "World's Strongest Man" contestants are any less likely to have health problems than the fat guys? I'm not so sure. I'm sure the insurance actuaries have a pretty good idea, though.

[cantunamunch]

Originally posted by AntiSoCalSkier
Or maybe you could come up with some sort of composite number based on a bunch of factors (mile run, bench press, resting heart rate, etc).

I use power(watts) per pound at AT for my own nefarious purposes. Still working up to 3.