Higher Insurance For Fat People?

      144 Comments on Higher Insurance For Fat People?

Two news article landed in my inbox recently that aren’t directly related to each other, but ought to be.  The first was about a company that’s going to start charging “unhealthy” employees more for health insurance:

Like a lot of companies, Veridian Credit Union wants its employees to be healthier. In January, the Waterloo, Iowa-company rolled out a wellness program and voluntary screenings. It also gave workers a mandate – quit smoking, curb obesity, or you’ll be paying higher healthcare costs in 2013. It doesn’t yet know by how much, but one thing’s for certain – the unhealthy will pay more.

In recent years, a growing number of companies have been encouraging workers to voluntarily improve their health to control escalating insurance costs. And while workers mostly like to see an employer offer smoking cessation classes and weight loss programs, too few are signing up or showing signs of improvement.

So now more employers are trying a different strategy – they’re replacing the carrot with a stick and raising costs for workers who can’t seem to lower their cholesterol or tackle obesity.  They’re also coming down hard on smokers. For example, discount store giant Wal-Mart says that starting in 2012 it will charge tobacco users higher premiums but also offer free smoking cessation programs.

I’m sure MeMe Roth would love the idea of punishing fat people for not being born naturally skinny like she was, but I don’t like seeing smoking and obesity lumped together.

Yes, quitting smoking is notoriously difficult, but people do it all the time.  Once the dangers of smoking were well-known and well-publicized, the rate of smoking in the U.S. dropped by half over the next decade or so.  Both of my parents – neither known for their iron wills – quit smoking in middle age.  That’s because, difficult as it was, they knew exactly what to do:  stop putting cigarettes in their mouths and lighting up.  (Like most people who quit, they quit cold turkey.)

You don’t quit smoking cigarettes only to find that two packs per day of Marlboro smoke is somehow finding its way into your lungs anyway.  But people go on calorie-restricted diets all the time and find (much to their chagrin) that they can’t seem to lose more than a few pounds … which brings me to the second article:

For years, studies of obesity have found that soon after fat people lost weight, their metabolism slowed and they experienced hormonal changes that increased their appetites. Scientists hypothesized that these biological changes could explain why most obese dieters quickly gained back much of what they had so painfully lost.

But now a group of Australian researchers have taken those investigations a step further to see if the changes persist over a longer time frame. They recruited healthy people who were either overweight or obese and put them on a highly restricted diet that led them to lose at least 10 percent of their body weight. They then kept them on a diet to maintain that weight loss. A year later, the researchers found that the participants’ metabolism and hormone levels had not returned to the levels before the study started.

Wait, you mean losing weight isn’t just a simple matter of cutting 3500 calories from your diet to lose a pound of fat?

No, of course it isn’t.  The body adjusts to try to become fatter again.  Hormones drive people to accumulate body fat in the first place, and hormones drive them to regain the weight they lose.  Look at what happened to the people in this study:

In the study, Joseph Proietto and his colleagues at the University of Melbourne recruited people who weighed an average of 209 pounds. At the start of the study, his team measured the participants’ hormone levels and assessed their hunger and appetites after they ate a boiled egg, toast, margarine, orange juice and crackers for breakfast. The dieters then spent 10 weeks on a very low calorie regimen of 500 to 550 calories a day intended to makes them lose 10 percent of their body weight. In fact, their weight loss averaged 14 percent, or 29 pounds. As expected, their hormone levels changed in a way that increased their appetites, and indeed they were hungrier than when they started the study.

Okay, no big deal so far, right?  They were eating less than before, so we’d expect them to be hungry.  But by gosh, if they’d just stick to that maintenance diet …

They were then given diets intended to maintain their weight loss. A year after the subjects had lost the weight, the researchers repeated their measurements. The subjects were gaining the weight back despite the maintenance diet — on average, gaining back half of what they had lost [emphasis mine].

That’s not character at work.  It’s biochemistry.  Their bodies were slowing their metabolisms in an attempt to regain the weight and reacquire a state of energy balance.

One hormone, leptin, which tells the brain how much body fat is present, fell by two-thirds immediately after the subjects lost weight. When leptin falls, appetite increases and metabolism slows. A year after the weight loss diet, leptin levels were still one-third lower than they were at the start of the study, and leptin levels increased as subjects regained their weight.

Other hormones that stimulate hunger, in particular ghrelin, whose levels increased, and peptide YY, whose levels decreased, were also changed a year later in a way that made the subjects’ appetites stronger than at the start of the study.

Your body doesn’t kick up your appetite because it wants to torture you.  It kicks your appetite because it senses a fuel shortage at the cellular level.

The results show, once again, Dr. Leibel said, that losing weight “is not a neutral event,” and that it is no accident that more than 90 percent of people who lose a lot of weight gain it back. “You are putting your body into a circumstance it will resist,” he said. “You are, in a sense, more metabolically normal when you are at a higher body weight.”

Bingo.  It’s like I said in my Big Fat Fiasco speech:  from a biochemical standpoint, you’re as fat as you need to be.  Your body defends a higher fat mass as long as it needs that fat mass to supply your cells with fatty acids for fuel.  To lose weight and keep it off, you need to be able to tap your stored body fat more efficiently – and that requires a change in your hormonal balance.  It’s not just a matter of cutting calories.

Months ago, I bookmarked an article on similar study that looked at the biochemical changes among former contestants on The Biggest Loser.  Here’s what the researchers found:

In an abstract presented at the most recent Obesity Society Annual Scientific Assembly, Darcy Johannsen and friends reported that by week 6 participants had lost 13% of their body weight and by week 30, 39%. More interestingly they reported that by week 6 participants metabolisms had slowed by 244 more calories per day than would have been expected by their weight loss and by week 30, by 504 more calories

That’s basically a meal’s worth of calories a day that Biggest Loser contestants no longer burn as a consequence of their involvement. Effectively that means they’re eating an extra meal a day.

Is it any surprise that so many contestants from The Biggest Loser – including the season two overall winner – have gained back all the weight?  All the “eat less, move more” theory did for them in practice was slow their metabolisms – again, beyond what the weight loss alone would predict.

I’m sure the companies threatening fat employees with higher insurance rates expect those employees to become motivated, eat less, and lose weight.  Without understanding of what drives fat accumulation, I think it’s more likely those employees will become motivated, go on a diet, lose a few pounds, stall, regain, give up … and end up paying the higher insurance rates.

If the bigwigs at these companies knew better and truly wanted to encourage (or coerce, to be more accurate) their employees into making positive changes, they’d base their insurance premiums on their fasting glucose levels – then teach them how to bring those levels down.  If I’m looking at a fat guy with normal blood sugar and a skinny guy with high blood sugar and had to bet which one will run up more in future medical expenses, I’d pick the skinny guy to cost me more every time.


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144 thoughts on “Higher Insurance For Fat People?

  1. The Older Brother

    Back on topic, there is a way the market, such as it exists, could settle this. Tom kind of alludes to this at the end of the post, but it won’t be resolved by enlightened employers, because they’re generally just passing on the insurance companies’ premiums.

    We all know that most of the medical establishment is pretty much bought off or willfully ignorant. Being completely cynical, you could posit that the current nutritional zeitgeist even increases their income.

    But what if some influential insurance company executive would direct her actuarial staff to take a look at health/life outcomes on blood glucose, statin use, LDL, triglycerides, etc. vs. the standard BMI/total cholesterol paradigm.

    In insurance, a few percentage point difference in actuarial risk accuracy can mean billions. How would you like to own stock in a company that took all of the overweight customers with normal blood work and declined or charged higher premiums to the skinny folks who are nonetheless pre-diabetic?

    An enlightened (by self-interest) insurance company would have the money and lobbying firepower to fend off Big Pharma and Big Ag while growing its bottom line by pushing people away from statins, flour, and sugar.

    Maybe some of the folks buying “pay it forward” copies of Fat Head or GC/BC could put some insurance honchos on their Christmas list.

    Cheers

    The self-interested side of me especially likes that last idea.

  2. Joyfulbaby

    I’ve really begun looking at people differently. Before, I would have seen the grossly obese three-year-old being pushed in a stroller around the zoo and rolled my eyes, but now I think: three, and her cells are already starved for some usable energy. Obviously, she and her (also grossly obese) parents are carb addicts, their fat cells are being stuffed with all the calories they eat, and they have no idea that if they cut out the carbs and add back the fat, they’ll probably have more energy, and that little girl will be able to walk around the zoo herself. Sad, yes, but not shameful.

    I’ve totally changed my outlook on huge people since doing the research for Fat Head.

  3. Debbie C.

    Right now I’m in the midst of my annual enrollment period as a company retiree. This year (despite being obese) I’ve been on the high deductible plan which costs me $0 per month, a good deal. But it has a $1000 annual cap on what it will pay for prescription drugs. No big deal now. I probably spend no more than about $150/year on prescription drugs. I don’t mind paying out of pocket. The only medical expenses I incurred this year were to see a practitioner who doesn’t take any insurance, to get my thyroid treated properly (as all the ones who TAKE insurance seem to provide CR*P treatment for hypothyroidism). But I do worry. Suppose I DID get hit with a major illness? Suppose I did get cancer? It wouldn’t take long (less than a week even) to use up that $1000 max. So I got thinking about shelling out more per month just to have peace of mind in case of catastrophic illness.

    So I took an online “health advisor” test which was supposed to evaluate your current state of health, and then recommend which plan might best fit your needs. And I actually decided to be HONEST. It had an entire nutrition section where it asked you about what you ate – created by WebMD so you can imagine what it was looking for.

    But I was HONEST, said I ate ZERO “healthy whole grains” for example, and lots of servings of fatty foods like cream, butter, cheese, fatty meats. When I completed the test and got my “score” it was pretty low – despite being a non-smoker, non-drinker, normal cholesterol,etc. It showed all the factors measured, with a little slider running from UNHEALTHY to HEALTHY for each category. Some where worse that others. My weight was still, of course, in the unhealthy catetgory.

    But the one that took the prize – the MOST UNHEALTHY, the one right at the very tippy top of the slider, the one that if one iota more unhealthy would be right off the scale, was my DIET. And yet my diet is one thing I consider the healthiest in my current lifestyle, and it’s allowed me to lose 130 pounds so far, which I am not only keeping off, but still continuing to lose. 🙂

    That’s why I’d never listen to WebMD. They’re basically a front for the pharmaceutical industry anyway.

  4. Stingray

    I know how well the low carb high fat works anecdotally but have not done all the research yet (beyond watching Fat head, thank you for that wonderful movie), but are there any studies on what this diet does to the hormones leptin and ghrelin? There has been at least one study done that shows weight training and maybe even high intensity interval training will reduce ghrelin. Personally, when I lift weights I am never as hungry as I am on the days I can’t make it to the gym.

    If those studies have been done, I haven’t seen them. Just studies showing that fasting insulin goes down. If Dr. Lustig is correct that high insulin prevents us from “seeing” our own leptin, that should make a difference.

  5. Galina L

    I didn’t became more hungry after loosing fat on VLC diet, so my hormones don’t push me as hard as people were pushed who were starving themselves. I wish they checked the difference in hormone level for dieters on different diets.. However, I am eating now at least one meal less than before without loosing weight (which is fine because I am at my goal). So, on LC , hormones slow my metabolism after a weight loss, but don’t tell me to eat more.

    I remember feeling famished after losing a few pounds on a low-fat diet. Never happens on my diet now.

  6. MikeC

    At my new employer, they actually pay you for hitting certain goals. $100 for taking a health survey and getting a physical. $100 for hitting a BMI target or improving your BMI by 10%. $100 for a healthy blood pressure. My only concern is the BMI, which we all know won’t work for everyone.

    Can’t say I’m crazy about the BMI target. What if you’re healthy, but have the beefy/muscular body type?

  7. Peggy Cihocki

    Higher insurance premiums for fat people. A fat tax in Denmark. Everyone seems to be tackling this at the wrong end of the problem. So sad.
    @Beowolf, ““If a vaccine was only effective 5% of the time, would you think that was a good medical treatment? No? Well, eat-less-move-more advice works about as often.” I totally love it! Am going to have to remember that the next time someone says or writes that it’s all a matter of eating less, moving more. Of course they will then say cutting calories and exercising is effective more than 5% of the time and point to all the people that have lost weight–again and again–on various weight loss diets. Because people mired in the old paradigms just can’t give them up, no matter how much evidence they are presented with.

  8. Dave, RN

    I work for a cardiac and orthopedic speacialty home health agency. Most of our patients are overweight/obese.

  9. cTo

    My thought upon reading this was imagining if my company did this and sent insurance adjusters around and they were all, “Hmm, well youre skinny and active now, but youre bringing in pieces of thick cut bacon for breakfast and red meat and butter-soaked vegetables for lunch everyday, so either you start eating the healthy microwaved brown sugar-flavored oatmeal and pasta lunches weve provided in the kitchen or youre gonna have to start paying up.”

    Funny, except for the fact that my company has been spamming us with ads for a subsidized weight watchers program in the last few weeks. I wouldnt put it past them taking it to the next step with something like this >.<

    If it happens, show up that day with a nice lunch of low-fat turkey on whole grain bread.

    Then when they leave, toss the bread and wrap the turkey around some bacon.

  10. Patricia

    I’ve wondered why insurance companies don’t strongly endorse carb restricted diets since they actually don’t have a financial interest in keeping people fat and unhealthy. Wouldn’t it be more profitable for them to keep their insured healthy? Less payout would mean they would be able to keep more of the premium payments (or even lower premiums). Yet, if you read any of the information provided by any of the insurers, they just parrot the conventional line. They’re big enough to have a significant impact on changing coventional wisdom. Just thinking.

    I’ve wondered that myself.

  11. Jan

    I suspect hypochondriacs cost the health care system a lot more than fat people who are tired of being lectured about something they have tried and failed to change–they’ve mostly stopped visiting doctors anyway. And if they’re like the generations of fat people in my family, they live just as long as their thinner counterparts.

    I think a Canadian study just debunked the idea that us fatties are the bugaboo. Maybe we ought to look instead at those who profit from drug costs and insurance premiums. I agree with Lori and others that insurance limited to big-ticket coverage is a very good idea. That way, insurance clerks wouldn’t telling your doctor how to practice medicine.

    On average, people considered marginally overweight (at least according to BMI measurements) have longer lifespans than thin people.

  12. Tammy

    The insurance piece poses a dilemma for me as well. I always think, my insurance rates are skyrocketing (especially prescription coverage) and I barely use it, but have to have it in case of catastrophe. I wish unhealthy people would pay more insurance since they are the ones using it the most, but unfortunately the efforts to measure”health” would be misguided so unless that changed it wouldn’t work. I was thinking maybe they could just use waist circumference ? But who knows…

    I’m not sure that would be a good idea, either. It leaves out the skinny diabetics.

  13. jethro

    According to the “set point theory” every person’s body has a pre-determined level of fat it wants to maintain.

    Eat less than this level, your body will slow you down and make you hungry.

    Eat more than this level, your body will accelerate your metabolism and reduce your hunger.

    The only known methods to reduce the “body fat thermostat” are:

    1. Exercise.

    2. Composition of the diet.

    There is no consensus on what is the optimal application of these elements.

    For exercise, some suggest a daily hour of hard aerobics. Others suggest interval training. Others suggest strength training and other suggest a combination of these.

    For diet some suggest low carb diets, others suggest bland diets and other suggest low fat (?) diets.

    Who is right? I believe you need to try these applications on yourself to see which apply to you.

    If you are losing weight, you are not hungry and feel energetic, you are on the right track.

    As always, find out what works for you.

  14. Richard

    A friend of mine, who is self-employed, recently decided to reduce her monthly health insurance bill by switching to a high deductible plan. In order to the qualify for the plan, the insurer required an A1C test and the result had to be below 6%. My friend passed with flying colors. What was interesting, the insurer didn’t really care about her cholesterol numbers.

    So at least in some states, insurers do have price incentives in place to eat and stay more healthy.

    That’s a good sign.

  15. Julia

    MeMe Roth is wackydoodles, man. She needs a case of beer and some saturated fat in her diet. Maybe she wouldn’t be so angry all the time. The fact that companies are sharing her mindset is really disturbing though (FAT= unhealthy, lazy, YOUR fault)

    This reminds me of that weight loss episode of The Office. It was a corporate contest to see which branch could lose the most weight. One woman kept fainting because of all the weird juice diets and crap she tried; just to drop weight for the company and try to win the contest.

    It’s like the contest, but it’s real life, and it’s real people’s health and finances. Sad. All I can hope is that this trend doesn’t continue.

    On another note, I’ve never taken the Biggest Loser seriously. It’s nothing more than an hour-long commercial for Jennie-O products.

    Yup, the goal should be health. Losing weight is a nice side benefit.

  16. Marilyn

    The following is about life insurance not health insurance, but the idea of charging higher premiums for people of less than “ideal” weight has been around for a while:

    http://www.halls.md/ideal-weight/met.htm

    The difference is the more recent attitude, expressed by the Veridian Credit Union, and too many other organizations/interests, that they “know” what is “healthy” on all fronts — weight, cholesterol, exercise habits, etc., etc. — and by gumbo people should be made to fit into those moulds or pay the price.

    Sure, those insurance tables have been have around for a long time.

  17. Paul L in MA

    This post falls into the intersection of interests of your two blogs!

    I haven’t read all the comments above to see if anyone else made this point yet, but…

    Nobody objects to car insurance companies charging more if you are a teenager or have a record of bad driving. (Or put another way, giving a safe-driver discount.)

    Doesn’t the hard-nosed, unsentimental libertarian in you think that it is justifiable for insurance companies to adjust premiums to knowable risk factors too? Even the factors that are not a matter of voluntary behavior? Not to be punitive or moralistic, but just to be economically rational?

    One would think their actuarial departments would have a great motivation to examine all the science even more skeptically than the scientists, and get the statistics very right.

    Doubtless though legislators would scream murder about it and it would not be permitted to happen. (“Community rating,” anybody?)

    I have no problem with insurance companies basing premiums on risk factors, but I think they’re missing the important ones.

  18. Paul L in MA

    Wayne, Patricia, Richard, and especially the Older Brother, of course — you all anticipated my point.

  19. Daytona

    My employer just started this as well. A nurse came into the office, calculated everyone’s BMI and performed a total cholesterol blood test. They said that for the first year, if you don’t submit to providing this information to the company your rates go up 16%. If you do, then they will use the data next year to raise the company’s rates based on how the entire group does.

    I was tearing my hair out because both tests are inaccurate, meaningless and I had no desire to give my health information to my employer. After people got their results back many people freaked out and decided to eat more hearthealthygrains and cut out the saturated fat. I have a feeling out rates are going to skyrocket next year…

    The law of unintended consequences.

  20. Stingray

    I know how well the low carb high fat works anecdotally but have not done all the research yet (beyond watching Fat head, thank you for that wonderful movie), but are there any studies on what this diet does to the hormones leptin and ghrelin? There has been at least one study done that shows weight training and maybe even high intensity interval training will reduce ghrelin. Personally, when I lift weights I am never as hungry as I am on the days I can’t make it to the gym.

    If those studies have been done, I haven’t seen them. Just studies showing that fasting insulin goes down. If Dr. Lustig is correct that high insulin prevents us from “seeing” our own leptin, that should make a difference.

  21. MikeC

    At my new employer, they actually pay you for hitting certain goals. $100 for taking a health survey and getting a physical. $100 for hitting a BMI target or improving your BMI by 10%. $100 for a healthy blood pressure. My only concern is the BMI, which we all know won’t work for everyone.

    Can’t say I’m crazy about the BMI target. What if you’re healthy, but have the beefy/muscular body type?

  22. Katy

    Let’s see… I’m fat because the clueless neurologist misdiagnosed my genetic condition (muscular dystrophy) and prescribed high dose prednisone, which I foolishly took for years. The drug screwed up my blood sugar levels and gave me gout and hypertension, and my muscles were further damaged by the steroids. My “poor health” is due to a genetic condition coupled with following idiotic medical advice, not by being fat! How stupid to assume that poor health has one or two causes, overweight and high cholesterol!! I weaned off the poison four years ago, and have lost some weight with a low carb diet. I rarely go to the doctor, yet I’d be charged more for health insurance because I’m still overweight and get practically no exercise.

  23. Jason

    They should start checking sick days used. This is my 8th year as a middle school teacher. This is the ONLY TIME I have ever made it this far into the school year without taking a single day off for feeling rundown, sick, and generally, like garbage. I haven’t felt the least bit ill at all. In fact, I haven’t had so much as a sniffle in the past 4 months. Oh, and I started the HFLC diet 4 months ago. Coincidence? Hhhmmmmmmm……….

    The number of sick days people take should certainly be a factor if they’re going to start measuring risk. They’d probably find some skinny people who low cholesterol who are nonetheless sick rather often.

  24. Lori

    “I suspect hypochondriacs cost the health care system a lot more than fat people…” Could be; I’m sure they take up more of their doctors’ time. Low office visit co-pays just encourage people to run to the doctor every time their kids have the sniffles. If you’re paying full freight, though, you’ll probably try some cold medicine first. My best friend’s ex-boyfriend, a total cheapskate with no health insurance, called Ask-A-Nurse when he smacked his eye really hard. It healed on its own, just as the nurse said it probably would.

    That’s why I want some buyer/seller sanity put back in the health care business.

  25. Dave, RN

    I work for a cardiac and orthopedic speacialty home health agency. Most of our patients are overweight/obese.

  26. Nick P

    Wow….great post Tom! I wish we could get the leaders in our country to listen and understand this…

    I have got a great idea:

    TOM NAUGHTON FOR PRESIDENT!!!!!!!!

    At least you wouldn’t have women coming out of the closet claiming sexual harrassment……(errrr….would you??).

    None that I know of … but keep in mind I was a heavy drinker for a chunk of my 30s. There may be episodes I don’t remember.

  27. Patricia

    I’ve wondered why insurance companies don’t strongly endorse carb restricted diets since they actually don’t have a financial interest in keeping people fat and unhealthy. Wouldn’t it be more profitable for them to keep their insured healthy? Less payout would mean they would be able to keep more of the premium payments (or even lower premiums). Yet, if you read any of the information provided by any of the insurers, they just parrot the conventional line. They’re big enough to have a significant impact on changing coventional wisdom. Just thinking.

    I’ve wondered that myself.

  28. Peggy Holloway

    After of year of employment, Whole Foods increases the employee discount for those who take a series of biomarker tests if they meet certain standards. My son, who is a low-carber by necessary, met all of the requirements and received “gold stars” on the markers for weight, body fat, triglycerides, and blood sugar. However, since his LDL was 113, 13 points above their cut-off (most likely due to the fact that he has high HDL and they used the calculated, not real LDL, and because he is a low-carber) they wouldn’t increase his discount. Ridiculous.

    That’s a silly measurement. If they really wanted to assess the risk of heart disease, they should pony up to measure particle size.

  29. Norman

    I’ve been eating and moving according to primal/paleo principles for about two years, but did not really notice metabolic changes until ditching a certain medication that inhibited glycogen formation in the liver. Now that my metabolism has healed, I find that I can eat whatever I want (as long as it is not wheat) till my satiety signals tell me to stop. The same hormonal regulatory system that keeps fat people fat, especially when they diet, was “reawakened” in me. It began to eliminate my “wheat belly”, as if it had discovered this excess fat around my midsection and said “What’s this doing here? Get rid of it!” And it will continue to do so till I reach my genetically determined body fat %. People I try to explain this to don’t believe it’s this simple.

    Glad you ditched the medication, whatever it was.

  30. Ailu

    Interesting about the metabolism slowing down after starvation dieting. That happened to me on every VLC diet I ever did (and there were many), except for the HCG diet. Desperate as the only alternative that we knew of at that time was gastric surgery, we decided to give it a go. My husband and I both lost 70 lbs each on it and only gained about 10 back in the past 3 years after doing it (and I attribute that to random ingestion of franken-wheat and MSG, both of which we avoid like the plague now).

    I think that is why researchers don’t believe it works – they’ve only studied the amount of weight people lost, compared to placebo. But they’ve never studied how it compared in keeping the weight off afterwards. From what I’ve seen, even low-carb has it’s limitations for weight loss, many people stabilize at a much higher weight than they’d like, no matter how low carb they go. I wish the medical community would really put HCG up to serious scrutiny and find out what exactly makes it work so well. Because if the online communities’ self-reporting is at all reliable, the success rate is much higher than anything else I’ve seen.

  31. The Older Brother

    @Debbie C:

    “It wouldn’t take long (less than a week even) to use up that $1000 max. So I got thinking about shelling out more per month just to have peace of mind in case of catastrophic illness.”

    If you’re only using a few hundred dollars a year now and don’t anticipate a real pending need, may I suggest you consider taking the additional money you’d spend for the “just in case” coverage and put that into an emergency fund instead? Maybe even add a little more if you can swing it.

    ——

    Also, as you’re enrolled in a high deductible plan and any of your pension (I’m assuming you have one since you said you’re retired and receiving health care benefits) or other income is taxable, you should check with your tax person to see if you can open an HSA (Health Savings Account). That way, the money you put aside is deductible. The limits for this year are $4050 plus another $1000 “catch up” if you’re over 55.

    Cheers

  32. Paul L in MA

    This post falls into the intersection of interests of your two blogs!

    I haven’t read all the comments above to see if anyone else made this point yet, but…

    Nobody objects to car insurance companies charging more if you are a teenager or have a record of bad driving. (Or put another way, giving a safe-driver discount.)

    Doesn’t the hard-nosed, unsentimental libertarian in you think that it is justifiable for insurance companies to adjust premiums to knowable risk factors too? Even the factors that are not a matter of voluntary behavior? Not to be punitive or moralistic, but just to be economically rational?

    One would think their actuarial departments would have a great motivation to examine all the science even more skeptically than the scientists, and get the statistics very right.

    Doubtless though legislators would scream murder about it and it would not be permitted to happen. (“Community rating,” anybody?)

    I have no problem with insurance companies basing premiums on risk factors, but I think they’re missing the important ones.

  33. Paul L in MA

    Wayne, Patricia, Richard, and especially the Older Brother, of course — you all anticipated my point.

  34. Daytona

    My employer just started this as well. A nurse came into the office, calculated everyone’s BMI and performed a total cholesterol blood test. They said that for the first year, if you don’t submit to providing this information to the company your rates go up 16%. If you do, then they will use the data next year to raise the company’s rates based on how the entire group does.

    I was tearing my hair out because both tests are inaccurate, meaningless and I had no desire to give my health information to my employer. After people got their results back many people freaked out and decided to eat more hearthealthygrains and cut out the saturated fat. I have a feeling out rates are going to skyrocket next year…

    The law of unintended consequences.

  35. Katy

    Let’s see… I’m fat because the clueless neurologist misdiagnosed my genetic condition (muscular dystrophy) and prescribed high dose prednisone, which I foolishly took for years. The drug screwed up my blood sugar levels and gave me gout and hypertension, and my muscles were further damaged by the steroids. My “poor health” is due to a genetic condition coupled with following idiotic medical advice, not by being fat! How stupid to assume that poor health has one or two causes, overweight and high cholesterol!! I weaned off the poison four years ago, and have lost some weight with a low carb diet. I rarely go to the doctor, yet I’d be charged more for health insurance because I’m still overweight and get practically no exercise.

  36. Jason

    They should start checking sick days used. This is my 8th year as a middle school teacher. This is the ONLY TIME I have ever made it this far into the school year without taking a single day off for feeling rundown, sick, and generally, like garbage. I haven’t felt the least bit ill at all. In fact, I haven’t had so much as a sniffle in the past 4 months. Oh, and I started the HFLC diet 4 months ago. Coincidence? Hhhmmmmmmm……….

    The number of sick days people take should certainly be a factor if they’re going to start measuring risk. They’d probably find some skinny people who low cholesterol who are nonetheless sick rather often.

  37. Lori

    “I suspect hypochondriacs cost the health care system a lot more than fat people…” Could be; I’m sure they take up more of their doctors’ time. Low office visit co-pays just encourage people to run to the doctor every time their kids have the sniffles. If you’re paying full freight, though, you’ll probably try some cold medicine first. My best friend’s ex-boyfriend, a total cheapskate with no health insurance, called Ask-A-Nurse when he smacked his eye really hard. It healed on its own, just as the nurse said it probably would.

    That’s why I want some buyer/seller sanity put back in the health care business.

  38. Nick P

    Wow….great post Tom! I wish we could get the leaders in our country to listen and understand this…

    I have got a great idea:

    TOM NAUGHTON FOR PRESIDENT!!!!!!!!

    At least you wouldn’t have women coming out of the closet claiming sexual harrassment……(errrr….would you??).

    None that I know of … but keep in mind I was a heavy drinker for a chunk of my 30s. There may be episodes I don’t remember.

  39. Txomin

    It is a bad idea to let insurance companies punish lifestyles, whatever those might be. Sure, we can point the finger to smokers (for example) and feel safe because they “deserve” it. But, ultimately, it simply opens the door to all kinds of crazy.

    I don’t have a problem with them taking behavior into account. If someone has six speeding tickets, I expect him to pay more for auto liability insurance than I do. My concern is that they’re picking the wrong measurements.

  40. Peggy Holloway

    After of year of employment, Whole Foods increases the employee discount for those who take a series of biomarker tests if they meet certain standards. My son, who is a low-carber by necessary, met all of the requirements and received “gold stars” on the markers for weight, body fat, triglycerides, and blood sugar. However, since his LDL was 113, 13 points above their cut-off (most likely due to the fact that he has high HDL and they used the calculated, not real LDL, and because he is a low-carber) they wouldn’t increase his discount. Ridiculous.

    That’s a silly measurement. If they really wanted to assess the risk of heart disease, they should pony up to measure particle size.

  41. Norman

    I’ve been eating and moving according to primal/paleo principles for about two years, but did not really notice metabolic changes until ditching a certain medication that inhibited glycogen formation in the liver. Now that my metabolism has healed, I find that I can eat whatever I want (as long as it is not wheat) till my satiety signals tell me to stop. The same hormonal regulatory system that keeps fat people fat, especially when they diet, was “reawakened” in me. It began to eliminate my “wheat belly”, as if it had discovered this excess fat around my midsection and said “What’s this doing here? Get rid of it!” And it will continue to do so till I reach my genetically determined body fat %. People I try to explain this to don’t believe it’s this simple.

    Glad you ditched the medication, whatever it was.

  42. Ailu

    Interesting about the metabolism slowing down after starvation dieting. That happened to me on every VLC diet I ever did (and there were many), except for the HCG diet. Desperate as the only alternative that we knew of at that time was gastric surgery, we decided to give it a go. My husband and I both lost 70 lbs each on it and only gained about 10 back in the past 3 years after doing it (and I attribute that to random ingestion of franken-wheat and MSG, both of which we avoid like the plague now).

    I think that is why researchers don’t believe it works – they’ve only studied the amount of weight people lost, compared to placebo. But they’ve never studied how it compared in keeping the weight off afterwards. From what I’ve seen, even low-carb has it’s limitations for weight loss, many people stabilize at a much higher weight than they’d like, no matter how low carb they go. I wish the medical community would really put HCG up to serious scrutiny and find out what exactly makes it work so well. Because if the online communities’ self-reporting is at all reliable, the success rate is much higher than anything else I’ve seen.

  43. The Older Brother

    @Debbie C:

    “It wouldn’t take long (less than a week even) to use up that $1000 max. So I got thinking about shelling out more per month just to have peace of mind in case of catastrophic illness.”

    If you’re only using a few hundred dollars a year now and don’t anticipate a real pending need, may I suggest you consider taking the additional money you’d spend for the “just in case” coverage and put that into an emergency fund instead? Maybe even add a little more if you can swing it.

    ——

    Also, as you’re enrolled in a high deductible plan and any of your pension (I’m assuming you have one since you said you’re retired and receiving health care benefits) or other income is taxable, you should check with your tax person to see if you can open an HSA (Health Savings Account). That way, the money you put aside is deductible. The limits for this year are $4050 plus another $1000 “catch up” if you’re over 55.

    Cheers

  44. mezzo

    This is not about health it’s about money. Insurance companies can charge higher premiums and pay fewer benefits, pharmaceutical companies get to sell even more statins and drugs needed to repair the damage caused by statins. The perpetuum mobile is here at last.

  45. Txomin

    It is a bad idea to let insurance companies punish lifestyles, whatever those might be. Sure, we can point the finger to smokers (for example) and feel safe because they “deserve” it. But, ultimately, it simply opens the door to all kinds of crazy.

    I don’t have a problem with them taking behavior into account. If someone has six speeding tickets, I expect him to pay more for auto liability insurance than I do. My concern is that they’re picking the wrong measurements.

  46. mezzo

    This is not about health it’s about money. Insurance companies can charge higher premiums and pay fewer benefits, pharmaceutical companies get to sell even more statins and drugs needed to repair the damage caused by statins. The perpetuum mobile is here at last.

  47. Stacie

    Totally off topic, but the good people at Fathead are so understanding. One minute ago conversation with my daughter (age 6): Me: ” Savanna, come in here!” Savanna: “:What?” Me: “Chicken skins!” Savanna: “Mmmm, tastes like bacon. Daddy, you want some?” Love it!!!

  48. Jennifer Snow

    Tom said:

    “We haven’t had anything resembling a true market in health insurance for a long, long time.”

    Right on, dude. This right here is the crux of the problem with health care in the U.S.

    I don’t mind being required to pay more for my personal health insurance because I’m overweight. I expect that old people and sick people will probably have to pay even more–because they incur more in health costs. Or that people who build their house on a sandbar will have to pay more for hurricane insurance. Duh. It’s just like any other form of gambling–if you want the big payoffs, you gotta shell out for the expensive tickets.

    What pisses ME off is when some company takes it upon itself to cut my wage reimbursement because they offer “benefits”, then squeeze me into some fascist bargain basement discount plan that covers me for stuff I don’t need or want but not for stuff I’d actually have a use for because I can’t afford my OWN insurance due to various political shenanigans.

    You know what’s sad? I’m obese and have been since I was 7–and you know what was the largest medical expense I’ve incurred since I was BORN? When I broke my arm AT WORK, which was covered by the company’s worker’s comp insurance. So basically 100% of every penny I’ve spent on medical insurance has been a COMPLETE WASTE. Yet people bitch because THEY are subsidizing ME?!

    I don’t THINK so.

    That’s why I’m self-employed. When I’m on a long-term programming job, like now, I work as an independent contractor. I use a payroll service to pay me and Chareva (who is technically my employee) and buy only the benefits we believe we need.

    (Now that I think about it, that means I’ve made sexual overtures to an employee … so I can’t run for president.)

  49. Stacie

    Totally off topic, but the good people at Fathead are so understanding. One minute ago conversation with my daughter (age 6): Me: ” Savanna, come in here!” Savanna: “:What?” Me: “Chicken skins!” Savanna: “Mmmm, tastes like bacon. Daddy, you want some?” Love it!!!

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