Life’s not simple when it comes to health care premiums

posted 11:37 PM 06/09
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Make sedentary, overweight smokers pay more for health insurance because they cost more.

Is this a tough-love message that asks Americans to grow up and face the consequences or a mean-spirited jab at people who already are struggling? Could it be a bit of both?

The retail giant Safeway runs a plan called Healthy Measures, available by voluntary sign-up. Annually, employees in the plan prove they are not smoking with a cheek swab, and have their cholesterol, blood pressure and weight checked. Those with perfect scores pay 51 percent less for health care premiums than employees with the worst health indicators.

The program has held Safeway’s health care costs level since 2005. Seventy percent of health care costs are driven by behaviors – such as food choices, exercise and smoking, a fact Safeway notices.

There is just one snag; what about the other 30 percent, those folks who end up ill despite healthy habits? Should they be penalized when life is already hard enough? Who decides who is culpable for their own illness and who is innocent? Is there a danger in charging people for being ill? Don’t the majority of people do the best they can?

Why is it that the people who point out the fat content of the food others’ eat can end up sounding like Orwellian health police? There is a razor-thin edge between compassionate encouragement, corporate pressure to keep costs down, and moral condemnation of the sick members of our collective herd.

What if illness is a season of life that’s natural, if not inevitable for some of us? Healthy, active people are likely to be in favor of any policy that asks sick people to pay more. Some of these folks look disdainful and mutter, “They did it to themselves.”

If only life were that simple. If cause “A” led predictably to effect “B”, then perhaps we could say each of us should pay for the accumulative toll of our decisions.

Life is not simple.

Imagine you take good care of yourself. You eat lean, fresh foods and exercise. No fast food. No smoking. A rare glass of wine. Five fruits and veggies a day. Everything in moderation. And unexpectedly you become very sick.

You miss work because of illness, and you miss more work even when you are somewhat better to receive health care. Though you have insurance, the medical bills accrue. The deductible, the out-of-pocket percentages – no matter how you slice it, you spend a lot of money on health care. Every month you have medication costs.

Illness takes away experiences, effortless contentment, your body’s trustworthiness and your vision of the future. And now, it takes away the money you had saved for a vacation or your child’s college. For some, it takes away the money needed for food, housing and basic utilities.

Imagine you have a child who has leukemia or your spouse falls off the roof and suffers multiple fractures or despite your health habits, you develop a serious chronic illness.

Now do you think you should be the one who pays more?

Or should we all pay somewhat equally, in recognition that some among us will at times be vulnerable. Perhaps there is a way to encourage health without punishing those unfortunate enough to be hurt or ill.

Pat Justis, a freelance writer, works in public health. A member of The Olympian’s Board of Contributors, she can be reached at pat@patjustis.com.

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