C’mon. The primary reason for breaking groups into subgroups, for insurance companies, is to extort a higher overall premium. Where is there *any* evidence that the cost of health insurance inspires healthier consumer lifestyle?

Starting next spring, Blue Cross/Blue Shield of North Carolina will offer some of the most extensive coverage for obesity treatment in the nation. The insurer is betting that the cost of helping people slim down will be lower than that of treating obesity-related diseases. NPR’s Patricia Neighmond reports.

http://www.npr.org/rundowns/segment.php?wfId=4120015

On the credit side: Higher premiums will be an incentive to move some fraction of the target demographic to better health.

On the debit side: Some fraction will remain unhealthy. Many (most?) will (1) lose coverage and become less healthy, thus depriving society of their labor, and/or (2) maintain health using “free” emergency medicine, which is a huge cost to society.

Given that obesity and poor health themselves are not sufficiently strong incentives to become healthier, why do you think higher premiums are uniquely superior as an incentive?

1. The slovenly, small-framed person with a high basal metabolic rate. (It is quite possible to be “normal” weight and have metabolic syndrome.)

2. The heavy and large-framed person who exercises and eats well.

3. The person who has an inborn abnormal drive to eat. These folks are rare but do exist.

4. The person whose ancestors were evolutionarily adapted to famine and therefore store fat like it’s going out of style. (Notably certain African subraces.)

5. The person who exercises and has a “normal” body fat percentage, but chooses very unnutritious foods.

6. The Standard American Couch Potato.

7. The poor overworked bastard who is slowly committing suicide-by-swivel-chair to provide essential services to you.

Objectively measuring health is not straightforward, and that poor health might be correlated with moral failure would not justify blanket punishment.