Ill considered

The State Health Plan shouldn't go ahead with plans to penalize some of those whom it insures.

October 11, 2009 

North Carolina's State Employees Health Plan, which veered off track financially earlier this year and needed a taxpayer bailout, now threatens to create a train wreck for its policyholders. Its intention to penalize those who smoke or are obese amounts to an inappropriate, overreaching intrusion into their lives.

As a news story last week reported, "North Carolina is poised to become only the second state to impose a fat fee on its state employees by placing them in a more expensive health insurance plan if they're obese. Smokers will feel the drag of higher costs, too ...."

Ideologues are welcome to debate whether a "fat fee" amounts to a "fat tax." The more essential point is that the health plan, which insures state government employees and their families, is going out on a limb. Instead of dealing with two notable health risks -- serious overweight and smoking -- by offering incentives for individual improvement (as many insurance plans do), it will impose penalties in the form of higher premiums.

The difference is crucial, because the latter approach requires that the plan actively identify smokers and fat folks, rather than encouraging nonsmokers and leaner people to step forward to claim discounts. There will be a chemical test, perhaps in workplaces, to root out smokers. As for obesity, the plan may monitor its insured by calculating individual body mass indexes, known to be an imperfect measure.

Even intrusive testing, however, isn't the most misguided aspect of all this.

Clearly, smoking and obesity are well-known health risks. But there are many others. A nonsmoker may not buckle his seat belt. Heavy drinking is an obstacle to a long, healthy life. Genetic conditions threaten many of us. Yet none of those risk-factors factor into the current equation.

Obesity is a particularly problematic condition to target in this way. Surely there's an inherited proclivity for some people to become overweight. And surely socioeconomic factors are at work; low-income people's diets often are less healthful than those of folks who shop at Whole Paycheck. Making poorer, fatter people pay what amounts to a penalty rate is cruelly unfair.

The State Health Plan understandably seeks, and needs, to manage its expenses. And encouraging people to quit smoking and lose weight is laudable. But the penalty route is not the way to go. The legislature, whose uneven oversight of the Health Plan is at the heart of many of its problems, should put the insurance plan back on the rails, remembering that the core principle of a group health plan is that the insured are all in it together.

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