"Second, fat can be avoided or reduced through exercise and healthy eating. If we charge fat people more for health insurance—or charge thin people less, which amounts to the same thing—people will improve their habits."

What bugs me is that this premise is invalid. Fat gain/loss is affected by genetics and hormonal balance as much if not more than eating habits. As such, there are many people who exercise regularly and eat well but are still at what US government charts consider an unhealthy (even morbid) weight.

There has been no study that has proven a significant long term weight loss benefit for "exercise and healthy eating." Yet, this new government plan is harping on that idea. It's hilarious that with one hand, the politicians are decrying "unproven medical techniques" as cost-inducing measures and on the other hand, they're trying to incentivize people to do something that is a sorely unproven technique. I'm sure that "big diet" has some influence here.

Also, it's funny how you never hear discussed that those "additional costs" that fat people supposedly incur include things like ineffective weight loss programs financed by insurance, unnecessary gastric bypass, and even in some cases, gym memberships under the guise of physical therapy. The cost is "healthy eating and exercise" as much as other conditions, and then it doesn't work.

This is prime case of correlation vs. causation. Doctors can't look inside your veins to see if you have plaque buildup from unhealthy habits, but they can look at whether you're fat, so that's what they do, because there are people who are unhealthy and who are fat...nevermind the millions of Americans who simply have a natural body weight and distribution that falls outside the norm.

Grr.

This is really the issue. An analogy to this would be to recognize that yellowed teeth and lung cancer correlate. But you don't reduce your risk of lung cancer by bleaching your teeth. Rather, you reduce it by not smoking - the cause of both the yellowed teeth and the lung cancer. Right now, the 'outcome-based' attention placed on weight is based on precisely this sort of "let's bleach away the lung cancer risk" fallacy. In reality, when your doctor advises you to lose weight, they only have about a 50% chance of being correct. In many cases, they're actually encouraging you to live a less healthy lifestyle.

There are recent studies showing that being overweight is not the primary factor.

The primary factor is fitness.

People who are overweight but fit (due to regular moderate exercise) die at lower rates than unfit people.

"Men and women who were fit, as judged by a treadmill test, but were overweight or obese had a lower mortality risk than those of normal weight but low fitness levels, the study in the Journal of the American Medical Association showed."

And don't even get me started about people like me who are fit, toned, and over the "optimal" weight for my height. For tall people, the optimal weight is calculated with endomorphs. If you are not an endomorph, it's basically impossible to have any muscle and meet the desired weight targets.

This is about control over our behavior because they can. Just like traffic lights and other kinds of data mining.

Basing health insurance on health related-factors is as unfair as raising the car insurance premiums on teenaged and drunk drivers. We live in a damn police state. Can't do NOTHIN' no more. And yeah, we do need to get rid of those damn traffic lights. No damn light is telling ME when to stop and go. I'm a man and I don't answer to no hunk of metal and wires and glass.

You lost me at: 'There has been no study that has proven a significant long term weight loss benefit for "exercise and healthy eating." '

Do normal-sized people stay that way from pure luck? Uhh, no. They watch their portion sizes, frequently they exercise. It's calories in/calories out, gotta change one side of the equation to lose weight.

Has some metabolic pandemic spread among the population over the last forty years? No. People are eating more, so they're getting fatter. That this is generally a bad thing is really beyond dispute. For one, weight is an excellent marker for poor health: there's both causation and correlation. And beyond dollars and cents, people simply feel better and look better when they keep excess weight off.

The real questions are two-fold: how to encourage people to lose weight and to keep it off and how to reduce external factors such as huge portion sizes in restaurants and "Super Big Gulp"-style excess in the retail industry. On the one side, providing financial incentives to watch their weight will hopefully encourage people to follow good habits. Look at cigarette smoking, taxes have increased, society has condemned smoking and per capita smoking has dropped significantly.

What's really not being addressed, or even really discussed, is the explosion in restaurant and retail portion sizes over the last 20 or 30 years. IMO, that's where this debate needs to go but large portion sizes are profitable, the industry is very powerful, and there's little political payoff in taking them on. So, people will keep getting fatter.

You're missing the point. It's more like raising car insurance rates on people with blonde hair, because everyone knows blondes aren't real bright.

Do normal-sized people stay that way from pure luck? Uhh, no. They watch their portion sizes, frequently they exercise. It's calories in/calories out, gotta change one side of the equation to lose weight.

Really? Because damned few of the normal-sized people I know do those things.

If damned few of the normal sized people you know don't exercise, then you don't know too many normal normal sized people.

Then you must know a lot of normal-sized people who are genetic freaks.

In the past before super-sized portions were the norm and there was a Burger King on every corner, there were relatively few obese people. Are we to assume that the genetics of the population at large changed dramatically over the past 25 years?

Whoever is paying YOUR health care bills has a right to control YOU. Don't like it pay your own bills.

That is NOT a police state. You appear to want OTHERS to pay YOUR way in life and to be able to do whatever you want on THEIR DIME. That is just being selfish.

Health related-factors can be used to set premiums as long as these factors can be changed by the individual by changing their behavior.

Now I agree that using gender and age should NOT be allowed even for car insurance premiums. BUT number of traffic tickets is fair, reasonable and logic. If you don't want an increase drive better and do NOT get tickets.

This is probably obvious, but my reply was to kgswiger, not Canada.

What bugs me is that this premise is invalid. Fat gain/loss is affected by genetics and hormonal balance as much if not more than eating habits. As such, there are many people who exercise regularly and eat well but are still at what US government charts consider an unhealthy (even morbid) weight

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The premise (that exercise and healthy eating can lower our weight) is only OCCASIONALLY invalid. Generally, though, we are fat because we eat way too much and sit around on our asses all day long. We simply have a perverted idea of when a serving of food is far too large and what it means to exercise. Hint: Watching a football game doesn't count.

As an educator, I come into contact with lots of foreign exchange students. Students from Eastern, Western, and Northern Europe, from Asia, from Africa, and from Central and South America.

They come to America, look at us, and wonder what the hell we have been eating that made us so goddamned fat.

Then by the end of the session, they dread going back to their native countries and explaining how they got so fat, themselves.

This is the argument for universal (or near-universal) coverage. If the insured population is very large, the companies will have a distribution of very healthy, moderately healthy, and unhealthy clients. It will all equal itself out.

For example, when I was a kid, Coke came in 6 1/2 oz. bottles. Now it comes in huge plastic jugs!

Noname: My apologies in advance, but your premise is pure BS. Yes, of course there are genetic and hormonal causes for obesity, but these actual clinical causes represent a miniscule percentage of the causation of overall population. What we have now is a flat out run away epidemic of obesity in this country. Even more insidious is the fact that this obesity is also epidemic in our children. This is totally preventable and reprehensible on the part of parents and is flat out child abuse.

I remember growing up and in grade school. Every class had 2 or 3 token "plump" kids. They weren't fat or obese compared to the kids I see every day now. We were all skinny little sticks. Heck, I had trouble keeping my pants up and belt tight enough. Mom didn't allow soda except for a treat once and awhile. Chips were only around at picnics and once every so often on a weekend. If we were hungry when we came home from school, and we always were, we were given carrots, apples, grapes, etc. to munch on until dinner. Then, Mom fed us well, and we always could drink all the milk we wanted (although not to excess, because our food budget was always tight). Today, junk food has become the baby sitter for kids coming home from school (not to mention all the crap they now consume at school), along with TV and video games. They sit on their collective butts and get fat.

You say there is no long term study regarding the benefits of a healthy diet and exercise. What planet have you been living on?! Studies like this have been going on since the 40s, and are constantly be re-done and upgraded to reflect changing society and norms. But the bottom line is simply that this is common sense. We don't need exhaustive clinic studies to figure out what is healthy and what is not. When health and longevity is studied in societies and cultures of every size there is always a common denominator: Healthy diet (high in natural fruits and vegetables, and low in meat and animal fat) and exercise. Often this situation is found in agrarian and village cultures where everyone walks as their form of transportation. The answer is quite simple: Put down the junk food, Big Macs, fries, soda, and KFC, get off your ass and walk further than to the fridge and back. Every time I hear one of your ilk whining about being fat is really just genetic and hormonal I want to throw up. And even worse, when I see your obese kids, I want to cram a big fat cream pie in your face.

Insurance companies and employers that promote a healthy life style want to save money and have a productive work force. Where on earth is your empirical evidence that "exercise and healthy diet" doesn't improve quality of life and overall better health? You are clearly in denial, as are the majority of obese people that choose not to change their lifestyle. Even the big greedy health insurance industry knows full well that a healthy population will make them more money in long run. Of course employers, insurance companies, etc. want to promote weight loss and healthily life styles: it's simply matter of economics. And believe me, our health care will collapse under its own weight (or more aptly under the weight of an obese population) if our country doesn't undergo a complete cultural change in terms of obesity. To be honest, social change is rarely the reason for change in a culture. When our country is bankrupt through healthcare, and half of our children have childhood diabetes, maybe some change might take place, but I'm not counting on it. Unfortunately, obesity is becoming the new normal. And your lame excuses are only perpetuating the situation.