The Dark Side of Health Care – Paying Extra Because of Our Health

There’s no doubt that obesity is an epidemic in the United States. 

Our children may be the first generation to live shorter lives than their parents thanks to obesity and the many related conditions such as diabetes, high blood pressure, cancer, and heart disease.

Among adults, according to the CDC, 35.9% of U.S. citizens ages 20 and older are obese.  Another 33.3% are overweight, but not obese.  That leaves slightly less than 31% of United States citizens who are at a healthy weight.

It doesn’t take a scientist to understand that those who are chronically obese or overweight will likely cost a company more in health care.

In addition, those workers are absent from the work place more often.  “A 2011 Gallup survey estimated obese or overweight full-time U.S. workers miss an additional 450 million days of work each year, compared to healthy workers, resulting in more than $153 billion in lost productivity” (Wall Street Journal).

While we may consider obesity a personal issue, each person’s obesity and related health issues affect not only themselves, but their employers and their families.

Should You Have to Pay Extra for Health Insurance If You’re Overweight?

More and more companies are arguing that employees who are overweight should pay more for their health care.

There seems to be two primary motivations here.

First, the overweight or obese person’s health care over several years will likely be more expensive than someone who is normal weight.  Obesity is directly linked to diabetes, high blood pressure, and high cholesterol.  In addition, other problems occur with chronic obesity including knee replacements and bypass surgery.  The employer will have to pay more for these employees’ health care, and they are passing some of that cost onto their obese employees.

Second, there may be a hope on the part of the employer that these financial penalties will encourage an employee to lose weight and live a healthier lifestyle, which will also reduce the employee’s chance of developing a chronic condition.

Whether this “incentive” will work is doubtful.

Many companies have already tried to offer discounts for those who maintain a healthy lifestyle, but few obese or overweight employees have changed their lifestyle.

Is Charging More Discrimination?

Calculate_HealthAs soon as the topic comes up that weight matters, everyone is up and arms.  People seemingly want to protect their right to maintain their current lifestyle, even if it is an unhealthy one.  They are quick to argue that charging more for health care is discrimination.

Is it, though?

When you apply for life insurance, you know you’ll get the best rates if you’re young and in excellent health.  My husband and I got our life insurance policies when we were 31 and 33, respectively.  At the time, my husband had been a non-smoker for four years and had a normal BMI.  I had a BMI in the obese range.  Despite the fact that the life insurance company still considered him a smoker, his premium is only $33 per month while mine is $46 per month for the same coverage.

Was it unfair?

Maybe, but I knew that by being obese, my chance of dying early was greater than my husband’s.  As such, I couldn’t begrudge the life insurance company for charging me more because they were taking a greater chance by insuring me.

A company that charges an obese person more for health insurance is doing the same thing.  They know there is a much greater chance the person will cost the company and the health care system more than a normal weight person.

I have been overweight most of my life.  However, I fell into the obese range after I had kids and stayed there for 8 long years.  I was able to skate along for years with no serious repercussions–until last year when  I had a series of health issues that were mild compared to what I could have experienced.  Still, I knew my weight had caught up with me.  I cleaned up my diet substantially and lost so much weight, I now have a BMI in the normal weight range.  My cholesterol, blood sugar and triglycerides have improved; I am much healthier, and I think I’ve headed off several potential health issues.  I’ve no doubt that I’ll cost my husband’s employer much less in health insurance going forward.

The Dark Side of Charging the Obese More for Health Care

There is always the risk that we’re starting down a slippery slope by charging the obese more for health insurance.

What’s next?  Not hiring someone who is obese?

Actually, the Cleveland Clinic no longer hires smokers, and Delos M. Cosgrove who is a heart surgeon and the clinic’s chief executive says that “if it were up to him, if there weren’t legal issues, he would not only stop hiring smokers.  He would also stop hiring obese people” (NY Times).

Scary stuff, indeed.

However, before we get to the point where we don’t hire people because they’re obese, as a nation, we need to look at our culture.

Junk food and fatty fast food is everywhere.  Let’s change the culture and promote healthy eating and exercise.  No matter the financial penalties, we won’t help people overcome obesity until our culture changes.

A look back in time shows we weren’t always this way.  The NY Times states that “people in their 50s are about 20 pounds heavier on average than 50-somethings were in the late 1970s.”

Listing all of the related cultural problems with our easy access to junk food is beyond the scope of this post, but all of the blame does not reside with an obese person.  It’s not just a matter of having no self-control.

Perhaps we can find guidance from the anti-tobacco movement. 

Increased taxes and social restrictions such as not being able to smoke in public places including restaurants and bars in some states have radically diminished the number of smokers.  The extra tax money has gone to educational programs to teach youngsters not to smoke, and it’s working.

Perhaps with measures like these, we can educate our population and teach them that healthy foods are better and that living a healthy lifestyle is worthwhile.

What do you think? Is it fair to discriminate on health care costs because of an employee’s health?

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Published or updated April 23, 2013.


  1. I agree that we as a society do not make it easy. We talk about health and eating right, but there are fast food restaurants on every corner and junk food is plentiful. This must change. I do think that incentives can work, but it has to be made tangible for the employees and more than just something else a company offers. I do know some have made it work, but they took it seriously.

    • Glen Craig says:

      With all of the lobbying and such that goes on it gets difficult to truly talk about what is healthy or not. We do need to do something though. One problem with incentives is the fine line between giving a bonus to one person and charging a penalty for another.

  2. Interesting question! Auto insurance will charge you more if you have accidents. Life insurance will charge you more if you smoke. Health insurance should charge you more if you are unhealthy. Being overweight usually causes more problems just like hypertension, high cholesterol, diabetes or cancer. Based on data, they should charge more for unhealthy behaviors.

    • Glen Craig says:

      It does seem to make sense, right? Like if you smoke you are taking more risk and should pay for it just like if you skydive for fun you might pay more for life insurance.

      But is it really an apple to apple comparison? I think health in our country had become muddled by a lot of bureaucracy. It’s a slippery slope I think.

  3. Let’s assume for a minute that they were to successfully enact this, my prediction would be that insurance rates might go up for overweight people, but they’re not going to go down a single penny for those who aren’t. In other words, the insurance companies would simply collect more revenue as a result. Either way, we’re screwed!

  4. For today’s generation, the habits established in childhood of highly sedentary behavior are very, very difficult to overcome. But it’s still overwhelmingly a behavioral issue, which is something that can be “discriminated” against legally in the workplace. As another example, a workplace can choose not to hire you because you dye your hair, but they can’t discriminate because your hair’s natural color is red, for instance. That’s why they can disallow all sorts of legal things, like smoking and tattoos and body piercings. So from a legal standpoint, yes, a business can choose not to hire someone based on their weight. And if the business is in a delicate financial position, being small or having narrow profit margins or being a start-up, they’ll be extremely motivated to choose the employee who will cost them the least, whether they have a formal policy or not. Charging an obese person more on health insurance might be the only thing that allows him to get the job offer at all, in these circumstances.

What Do You Think?