Should Fit People Get Discounts on Health Care?

A recent study found that 17% of U.S. health care costs are related to obesity. Our weight problem is costing us – not just in terms of our overall health – but in our pockets, too.

The financial burden of obesity is one that all Americans with health care must bear, regardless of fitness level, as the cost is factored into all our plans. It begs the question: Is this approach fair?

In a country like the United States, would it make sense to offer a health care discount to anyone that could do a pull-up and push-up? Or, in a country like Canada, where the health care is universalized, would it make sense to offer a rebate for fit citizens when they efile their taxes – as they are less likely to incur health care expenses? Perhaps this financial incentive would motivate people to become healthier.

On one hand, unlike conditions like cancer or cystic fibrosis, obesity is avoidable and easily curable. Though many factors go into obesity (it is often deeply psychological), changes can be made both on the inside and out that result in a reversal of the condition.

But on the other hand, providing a discount or tax break to fit people would favor wealthier individuals; there is a strong link between obesity and low-income communities. Low income individuals often have greater barriers to physical activity and less access to healthy foods and supermarkets. In other words, such a discount or tax break for people would further impair the people with the least.

So what do you think? Should the extra financial burden of obesity be carried just by the people causing it? Or should we all bear the financial impact of obesity? Does giving a discount or tax break to healthy individuals make sense, or is it a socially unjust incentive?

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Comments

  1. I would not penalize those who are obese. However I would penalize cigarette smokers.

    There should be tax incentives for choosing healthier paths. For example, rather than have a gym membership be subject to sales tax, as it is in the state where I live, you should get a tax deduction for your dues.

    • That’s a great point. While it may be hard to sell obesity as a complete choice – smoking, or at least starting to smoke, certainly is. My health plan is more expensive for smokers, but I don’t think this is taken into consideration with universal health care plans.

      • Oliver Beatson says:

        (This is to the best of my memory) A study in the 90’s, in a country with a socialised health-care system, showed that smokers cost something like 40% less than average citizens in healthcare costs, simply because they died earlier and from less medically-expensive things; and that the tax on tobacco more than made up for the money spent on smoking-related illnesses without even considering the tax they otherwise paid for the healthcare system.

        But then why even bother with tax incentives? Why pick and choose which incentives are ethically enforceable on the country, by a state-based health provision? It only allows special interests to have influence (relative to the size of the government which in this case is pretty big), leaving the indirectly paying customer, too often disenfranchised. At least in a free market supply and demand are allowed to directly meet, no middle-men or special interests or coercion.

        It’s confusing to see some people say the government should ban the free market because the market is harsh on some people, only to impose that harshness elsewhere in selective taxing.

      • Is smoking a complete choice? Do we not say that people under certain ages are not legally capable of making certain choices. For example: Sex, drinking, smoking, war, etc.
        You have to be a certain age before you are considered to have the ability to “choose” to drink, smoke, or have sex. Most people start to smoke before this age; they become addicted to smoking while they are not even capable of making a true, complete choice. Why should this kid be punished 20 years in the future for a mistake he makes today? People only have the complete and true choice to smoke if they begin to smoke after they are an adult. Most people started smoking at something like age 13. But, people want to penalize this 13 year old for beginning to do something and thereby getting addicted at age 13. When this 13 year old turns 30, he/she will still be addicted, and you will say, “It is his/her choice.” That is just B.S. – unless he/she began smoking when they were like about 20. Stop being so hypocritical.
        Next time you look at a 13 year old that is smoking, tell him/her, “I am going to stuff it to you in about 10 years for what you are doing now, you little brat.”

  2. I live in Australia, and they offer better health care for singles and couples, so just for here in Aus I think this would be a terrific idea, as obesity in Australia isn’t just specific to one income earner.
    And the idea for smoking is good as well.

    But truly I think it comes down to health care establishment, because as a 1st world country America doesn’t really make it as one of the best, where in Australia we have a very well established health care system.

    This enables us to get cheaper private health insurance but also there are these ‘rewards’ and at the moment we have a situation where if you are healthy enough and don’t claim then you are also rewarded. So that could be another idea.

  3. Trevor Wright says:

    While you can’t really say obesity is a choice, you can say that many of them continually make poor health choice that healthy weight people do not. So I say that people that are at a healthy weight should get some kind of discount because they don’t have or are not expected to develop some of the condition that an obese person will. If there is anything that the law can do is prohibit doctors and the government from issuing handicap decals to people just because they are obese. If anything they should be required to park farther from the entrance to supplement the exercise that obese people need. It is ridiculous that there are elderly people in wheel chairs that are having to park in general parking because there are no handicap spots open because they all have obese people parked in them that are more then capable of walking. (This is a big problem in the South due to the high rates of obesity here.) But that is just the view of a 21 year old who is skinny.

  4. Like tobacco products, tax ALL junk food to encourage people to make healthier choices too. Use that tax for public health education and health-care programs.

  5. Matthew McGuire says:

    Do you realize you are gay? And dont you want to be treated equally from your government? you realize even though you are gay it still is technically a choice that you sleep with other men… and this puts you at a much higher risk for Aids. So question should you discover that you have aids should you pay more for treatment where someone who got it from less risky women gets a discount? The fucking insane idea you have come up with is in-equality of heath care and as a Canadian it frankly makes me sick. I believe in universal healthcare where everyone, gay, straight, obese, lean, smoker, non-smoker, rich, poor gets equal health care.
    Now I personally have never lit a cigarrette, im healthy, lean, and active. I have good blood pressure, and low chance for anything to go wrong. BUT

    Isn’t equality what people fight for… have died for?

    • I understand the point you are trying to make here, but the fact that he’s GAY no longer puts him at a higher risk for AIDS, it’s the fact that he is not in a committed relationship or marriage.
      People who engage in promiscuous sex are at the highest risk of HIV. That includes straight people. Unfortunately, while gays don’t necessarily have sex more often than straight people, they do tend to have it with multiple partners more often, and make no bones about it. So, being a gay man in and of itself does not put him at higher risk of contracting HIV, but his sexual behavior, much like a smoker or over-eater’s is affected that could put him at higher risk.
      Yet, this is topic for another discussion…

  6. If money is an incentive, then yes, it might help to offer rebates/discounts, but in the UK more lower income people have smoking/drinking/obesity related problems than high earners. People do it whether they can afford it or not.

    It’s a slippery slope, though, to start denying healthcare for reasons of personal choice. It’s probably easier for insurance companies to do it than governments.

    On a side issue, i find it unreasonable for airlines to charge me excess baggage for being 4 kilos over the limit when someone next to me weighs 50 kilos (110lbs) more. I know that makes me sound like a fascist… i’m not…

  7. Rather than penalize or provide incentives they should properly (key word here, the current edication systm sucks at this..) yeducate, or subsidize programs to help people become part of the fit group. I have been very overweight in the past, but through basically a diet training program (which is very expensive..) I learned how to eat and exercise properly to my body type. People can talk all they want about calories in vs calories out, but that is meaningless when no one knows what calories out actually is. There are many factors at play in these situations and no one should ever feel as if they are being penalized because of it. It would really depress me to see such a policy passed. Of course the first steps always have to come from within, but once that has happened how about a little support?

  8. I think obesity should be treated like any other chronic or pre-existing condition. It could be argued that athletes are more likely to injure themselves and develop chronic condition that may require numerous surgeries and physical therapy sessions. Ask any football or baseball player how often they see a doctor and multiply that by whatever copay you have and I can imagine it’s not so far off from what an obese person may incurr. Besides which, some people are simply pre-disposed to being heavy. I know someone who is a borderline vegetarian, grows her own fruits and vegetables, has chickens in her yard, eats small portions, and buys organic while leading a very active lifestyle, and she still struggles with weight issues. I know another person who is the absolute picture of fitness but still has to be vigilant against diabetes and heart disease and fight issues of anxiety for which he needs to be medicated. Health is a multi-faceted and extremely complicated and even somewhat issue. The moment you start offering discounts to a group of people who meet the subjective definition of “fit” you open the door to descrimination and disparity and suddenly that “universal” health care doesn’t seem so universal

    • It may also be worth adding that there are people out there who seek medical remedies and solutions for too easily, which often causes more problems in the long run. For example, I have lower back issues. Nothing major, but the first thing people tell me when I bring it up is “go see a doctor for pain killers”. I’d rather seek regular therapeutic solutions like massage, compresses, etc., than deal with the artificial things prescribed by doctors. Even still, pain killers, don’t resolve the problem, they only mask it. So, when it comes to surgery, more times than not, that leads to more complications and more medications, and probably more surgeries.
      These are all things to consider when discussing a topic like this. When growing up, if I got so much as a case of the sniffles my mom brought me into the doctors to make sure I didn’t have anything life threatening. Sure, she was airing on the side of caution, but such things back up doctor’s schedules, and these things cost us more money in premiums in the end.
      Maybe we can start with practical solutions to our medical woes first before we start trying to structure things to benefit one group of people while being exclusionary to another?

  9. John Drover says:

    I would think this one fits into the “slippery slope” argument.

    You may think that fit people, and probably those that attend the gym, or participate in other sports and or fitness activities are less of a burden on health care. But what about the cost of treating sports injuries, knee surgery, knee and hip replacements, etc.

    Just because you live an active lifestyle does not mean your health care is cheaper. It just means you live a healthy lifestyle.

  10. I like this question, on the west coast in California where i live we have a hospital called kaiser permanente not sure if they have them everywhere, but if you live healthier they will give you discounts. like if they know you smooke they dont make it expensive they just keep it the same but if you want to quit and you do they will help lower your medical bill and if you exercise and eat healthier they will also lower it down as well. I’m no longer medically insured but when I was they said if i went to events that if you sign up for them they will work to lower your medical bill never did it but i bet alot of people would if there is an incentive to. you can tell who cares and who doesn’t. If you go to your doctor and can’t loose weight then it could be a condition but if you just don’t try and you are obese then you know where you are at and don’t want change. I see this for some a very delicate decision but i think if we are smart about it we can make a good decision that can be fair.

  11. i think that the taxes on things like “junk food” and cigarettes should subsidize health care. penalization for poor choices is, to me, solidly a bad idea. discounts for healthy choices sounds like an invitation to lie and defraud; and also like a way to penalize poor choices without saying that’s what’s happening. how would we determine the legitimacy of self-claims that any given person is healthier? how do you prove that you exercise [correctly]? how would you prove that you eat a low-saturated-fat, vegetarian or semi-vegetarian diet? how would you prove that you only drink water and non-calorie beverages? if you don’t smoke but you test positive for nicotine because you were in a second-hand smoke situation what do you do then? what do we do when we incorporate testing for genes that are known affiliates of health problems? it sounds like a hot mess. perhaps we’d keep it simple at first but what then when the paperwork and testing gets out of control? if you didn’t get a discount on health care for making more responsible decisions about your health would you stop making them? i don’t think “healthiness” needs any sort of recognition like a financial discount.

    • How do I “lie and defraud” if my gym membership, which can be documented like any other tax deduction, is deductible?

  12. No I do not believe being fit entitles one to discounts. Health is a whole life approach not just the physical. Since it is impractical and liberty depriving to dictate lifestyle and mental health on top of genetic and other causes of bad health, it breaks down to actual need.

    It really should not be an issue of how its distributed except in willful disregard for ones health. I mean just because your obese, like you said Davey, does not mean its completely choice. There are many factors to it.

    If prices are distributed and individual costs lowered it makes health care more accessible to people and in the end that’s a healthier society. To penalize people already unhealthy could make them even worse off.

    In my opinion we would be better served providing free health education from fitness to nutrition, cheap or free access to fitness centers, and ensuring everyone can acquire healthy foods at reasonable prices.

    When we tackle the problems proactively we can head off many issues. The idea of penalizing people who are already unhealthy just adds extra stress on them and reduces there ability to get help even more.

  13. I have a couple of different thoughts on this question. First… I have concerns about the privacy aspect. Consider someone in the US filling out their 1040 every April and two boxes in the form are “Weight” and “Height”, which you then look up to determine a BMI or some other measure, which then translates into a tax incentive… Do you really want the government knowing that information? How about enforcement? How would an auditor verify that information? If we’re just giving that information to the health insurer rather than the government in exchange for lower premiums, we need privacy protections in place to prohibit use by the company for other purposes and possibly an opt-out mechanism.

    The second point is that a lot of the obesity problems we face are a large result of public policy. We encourage people to live in the suburbs and sit in the car and drive. We’ve eliminated or cut back physical activities in educational environments. We have subsidized corn producers to the point that high fructose corn syrup is so cheap that it’s prevalent all over the place. I guess my point is that it’s like a fish swimming up-river… everything (particularly in the US) is geared toward making people less active. It’s really difficult to maintain a truly healthy lifestyle.

    Having gotten both of those points off my chest, the power of incentives are incredibly powerful. If an effective way to financially encourage healthy choices could be created I think it would be a great way to challenge some of the problems we’re encountering. However, it would need to address the perverse incentives already in place in other areas of public policy and would need to protect a person’s privacy.

  14. What would really be beneficial is to reduce the profit margin for corporate farmers who have no interest in the public health, but simply produce beef, fowl, fish and pork with little regard to anything except how rich their getting.

    Reducing the profit of having oversold beef to a captive market (the obese individuals who only watch television for their leisure activities), by reducing the farming subsidies to big farming corporations makes sense.

    Investing in little farming grow-ops to make fresh local produce and reduce transportation (and road maintenance) costs would benefit everyone.

    Cheers!

  15. I think it would be hard to classify “junk food”. One example I can think of is say potatoes are not junk food, but potato chips are right? what if I buy potatoes and go home and fry up some potato chips? It will be hard to draw the line. Are fruit snacks that are made from only fruit “junk food”.

    I do think it would be cool to have some tax supported health incentives. Maybe government sponsored gyms or something. And definitely education is important.

  16. in order for health care to be even sort-of cost effective, the risk and cost has to be spread out over a diverse population of insured individuals… offering a discount to healthy people is like red-lining people with pre-existing conditions.. it shifts the cost of health care disproportionally on to the people who are least likely to have insurance let alone afford it… “it takes a village” is as true for good health as it is for raising a child… too often in our great country we tend to look at stuff from the perspective of us vs them… enough! we are all in this together…

    ~ cheers…. david

    p s.. if we can penalize people who “choose” to be obese, or smoke, what about people with hiv/aids? ryan white may have been an unsuspecting victim, but we all know the risks… if we “choose” to ignore them, and get infected, are we any less worthy to access affordable health care?

  17. Yes you should get discounts. If people smoke then their health insurance is more. The insurance company is taking a larger risk insuring them. I believe if you are a healthy weight then then your insurance should be less. If you are healthy person and have had blood test come back good you should get discounts. I work hard to stay healthy and I pay outrageous medical bills. In Maine for me to have health insurance it is $700.00 a month. Crazy.

    Wes

  18. Hi Davey.As a safe driver,I pay less for my auto insurance.Why not the same for health ????? GP

  19. I’d love to get a health insurance discount…

    here in parts of Europe you get points for being a member at a gym or seeing the doctor once a year for a check-up. As a student I don’t have the money for an expensive gym membership yet I live a very healthy lifestyle (regular exercise, vegetarian diet etc.)That doesn’t get me any points and the annually check-ups don’t add up enough to get a discount from the health insurance and IMO that’s unfair!

    Fit citizen should pay less

  20. This is a disgusting idea suitable for the 3rd Reich only!

    Health care is universal – full stop.
    If it isn’t then it comes awfully close to choosing who is and who isn’t worthy of health care – thus, who is or is not worthy of life.

  21. I liked the tax rebate system. I know this sounds cruel but let’s say that if you’re fit and healthy you get the rebate.
    This would obviously piss people off who are angry and they’re just going to sue for discrimination and probably win (It’s not like they have the republican party and the mormons shooting all of there efforts for equal rights hmmm?)
    So why not offer people who don’t qualify for the rebate a program with a specific target weight to reach by the end of the year to receive all/part of the rebate. This would give them drive to lose weight and also gives the healthcare some ground to stand on because they’re offering them help too.
    The biggest issue with that is does the health system have manpower to design and uphold such a promise?

    Shout out for free healthcare!

  22. What is “Healthy” and how will this be judged. And even if we did bring in something like this, then what about the people that are obese by genetics? Or health problems? or just physically unable to keep fit? do we just give them all germaine? but then what about the people who have hearts problems?

    Im not saying is cant be done, but there is alot of things around it that need to be considered.

  23. I really agree with Ian. Defining the perimeters around such an effort is tricky. I also like what Ross said “So why not offer people who don’t qualify for the rebate a program with a specific target weight to reach by the end of the year to receive all/part of the rebate.” I think that is an excellent idea, but still doesn’t address the issue of access.
    I’m almost the opposite in regards to dealing with the issue of obesity. I am a bit of a socialist, and believe that if a marginalized group is not enjoying the same quality of life it’s more important to help them then to penalize them, and a tax incentive for fit people would in essence penalize those that are not fit.
    I live in Canada, and believe even our much discussed health care system is in need of reform. But I am also lucky that in my community there is a form to decrease the cost of fitness classes and gym costs if you are a “low income earner”.
    I think there should be an incentives for obese people to get fit, ie: tax breaks if they go to the gym (similar to what Ross said), community gardens to access healthy food, etc… It would be a complicated system to develop and implement. I strongly encourage healthier eating as a way to combat obesity, so I think what would really help is community gardens. As long as they are implemented in an efficient and productive way, through schools in conjunction with neighborhoods, so people learn to actually grow their food and enjoy the “fruits” of their success.

  24. I agree with most of what Shi has said. The problems of obesity are complex and cannot be simply associated to junk food therefore we should not tax junk food. The same issue surrounds smoking and buying smokes. I am from Ontario, Canada and the government has increased the tax on smokes almost every year but that has not detered everyone from smoking (has had limited effect). The other means of decreasing the smoking population is to provide a support system like providing Quite Smoking programs that provide nicorette patches for free or have grand prizes for people who stop smoking.

    Instead of focusing on the “Fit person” getting discounts, there should be a tax releif on health activities or products (like fitness center memberships). An increased awareness program could also be introduced that provides tips on how to eat healthy on a tight budget (Community Garden or Community Kitchen is a good idea as well).

    Lastly, do you measure a person by physcal looks, weight, BMI or some other means? How do you measure how “Fit” someone is? And does Fit mean Healthy? Does everyone have to visit the doctor and get a “Fit” or “Healthy” stamp to get a tax reduction? You could look like Davey Wavey and not be healthy or not look fit but be healthy. (In no way am I commenting on Davey Wavey’s Health or Fitness level just using it as an example)

    • Catherine says:

      There are ways to measure fitness on a health level. One way is called a stress test. This measures your muscular but mostly cardiovascular health. Getting (and passing!) one as part of a physical to earn a discount is a great idea. If you’re going to cost less to the insurance company than they should charge you less, and all evidence points that obese individuals cost the healthcare system more.

      I’d also like to say that obese because of health problems is overstated. I have a thyroid that pretty much doesn’t work. Most people with T4 levels like mine are clinically obese, yet because I monitor my intake and exercise I’m able to remain on the higher end of the acceptable range according to the BMI scale.

      I do like the idea of part of the rebate if you make efforts and meet goals along the way to the health goal. Many people need support in order to continue to make healthy choices. But because I’ve struggled against a condition that typically causes obesity and won- I feel a certain hostility to those that just give up. It’s like you said Davey Wavey, respecting your body is part of respecting yourself.

  25. Yes, fit people should definitely get a discount on health care. And I definitely like how you said “fit people” not just thin people. I know plenty of thin people who are very unhealthy, so that’s not always a good way to tell.

    And as far as being fit being correlated to money, that’s SUCH a bullshit excuse. I’m a broke-ass, and I manage to stay fit and healthy. I do videos at home instead of buying expensive gym memberships. Hell, you can buy all three of your programs for just $100. That’s something that pretty much everyone can afford. And when it comes to eating, it’s true that the very healthy food is more expensive, but that doesn’t mean that people have to be shoveling down fast food and whatever junk food they buy. It’s just about being conscious of good decisions. That’s just what I think.

  26. Steve Dexter says:

    Great discussion. I read the article with the idea that insurance companies should have a special rate for folks who are “fit”. When I was on active duty in the Navy we had twice a year fitness tests – waist/neck measurements, stretch to touch the toes, pushups, situps, running 1 1/2 miles. Most of the physical stuff gave us points which, using age brackets, gave you a grade. BMI was also calculated. In the end you got a score – that helped to determine whether you got to stay in the service and got you a grade (fail/pass/outstanding) for your next evaluation. We should recognize those who attain certain fitness levels but giving discounts on health insurance merely shifts the cost burden (rightly perhaps) to those who are less fit. Unfortunately that also introduces all sorts of other issues: discrimination, cheating, political wrangling and the like. In one respect fitness is its own reward: you feel better, you visit the doctor much less and you like yourself better. Also folks will likely give you some recognition as well. Good all around. Thanks for all the good ideas you all wrote. Well done.

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