Obesity Benefits Penalty?

Check out this post over at Pandagon by Pam. Apparently, the state workers in North Carolina will soon get differing benefits for their healthcare policies dependent upon their BMI. Currently, all state workers are in an 80/20 plan, meaning the policy pays 80% of medical costs and the employee pays out of pocket 20%. Next year, individuals with a BMI of 40 or above will have to pay more out of pocket than lower BMI employees. The NEXT year, the BMI requirement shifts down to 35--so everyone with a 35 BMI or higher will have to pay more out of pocket for their healthcare expenses (even those unrelated to obesity).

There are several problems with this--its discriminatory for starters, but lets take all the justice issues out of the equation for a sec and just talk about efficiency. Is this program really designed to encourage people to get healthier or is it a punishment for the super popular whipping boy/girl, the fatties? I think the later rather than the former. For starters, reducing the income of the obese is not likely to help them (us) to afford the gym memberships, the fresh fruits and veggies and lean proteins, or the time (have to get a second job to cover the added expenses) to exercise and engage in a stress-reduction regime. Its a punishment and if you check out some of the message boards and blogs that are talking about this issue in North Carolina that Pam cites, the outright glee and sense of self-righteousness on the part of the fattie haters is evident. The "personal responsibility" troupe is brought out time and time again. But the truth of the matter is, there are a number of reasons someone might be obese or overweight (medication interaction, underlying conditions, disabilities, the shifting BMI standards, etc.) yet in spite of all that, obseity is also a collective, public health issue that has grown more and more common by our structural decisions as well as social customs. That is to say, the city and small town planning decisions that make the USA extremely car reliant directly impact our activity levels. The Agriculture Bill (which industry insiders like to call the Farm Bill, but its not about family farms, but factory farming and industrial, fossil fuel dependent agriculture) essentially has the American tax payer subsidizing the fast food and convenience food industries at the expense of our own health and interests. Labor laws did wonderful things in the 20th Century to improve the health and safety of industrial workers, but in the 21st Century we need more integrated exercise into the information and white collar, sendentary work life for our health and safety. Today, I work at a University, we had a Wellness Program sponsored mile walk. Many of the Dean's as well as support staff attended the event and it was to count as work time. It was nice--I got a free pedometer and a chance to take a walk. But once a year this does little to encourage administrators freeing employees to exercise. If they allowed hourly employees (and salaried, but still stuck to the desk employees) the freedom to take a mile walk 2-3 times a week without having to stay after the general working hours to do it, we would probably be MORE productive. Certainly happier and healthier. Integrated exercise into the workday will be key in the 21st Century, but it probably won't be commonplace unless we work to make it so. As a supervisor, you have to ask yourself: do I care about productivity and the health of my employees or following a set clock schedule (during which 1/2 of everyone screws off probably 2 hours a day surfing the net anyway)?

One thing that I find ironic about the NC state workers obesity punishment plan is that many of the people enjoying calling the fatties "fatties" or "irresponsible" or "lazy" or "ignorant" is that once the BMI punishment level shifts down to 35, many of fattie haters will then be enjoying the fruits of fattyland themselves (and whose to say it won't eventually fall to 25, which is the cut-off for normal/overweight?) Incentive programs work better than punishments, but you know what really works? A social committment to helping all individuals seek out the best health goals they can achieve. As a nation we are overworked, under-nourished, yet over-fed and seriously lacking in the kind of daily activity (like walking to the post office or fruit stand) that our healthier (yes, thinner) and more content European and Japanese counterparts.