Is it fair for insurance companies to charge higher premiums to smokers and/or obese people

It Is Unethical For Smokers and Obese to Pay Higher Premiums
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Research indicates that obesity and smoking related illnesses consumes hundreds of billions of dollars a year in the United States health care expenditures and lost productivity (Madison, Volpp & Halpern, 2011). Given the high levels of economic and medical tolls of smoking, it is not surprising that more than 50 percent of the American people may favor imposing higher health insurance rates to smokers and obese people to provide them with further incentives that will make them stop smoking. The Affordable care Act (ACA) signed by President Barack Obama, allows all the employers providing health insurance and the private and public health insurers to impose higher insurance premiums of up to 50 percent higher rates (Madison, Schmidt & Volpp, 2013). A utilitarian argument may point out that increasing the premium charges of smokers may encourage most of the smokers to quit the act, thus promoting public health and reduce the costs incurred on smoking in the country’s budget. Other studies also indicate that introducing monetary incentives is likely to increase the rate of smoking cessation among the members of a given society. However, I disagree with these views since I consider this move as unfair to the people who smoke or the obese people. These groups of individuals have their individual right and freedom to conduct themselves as they wish and no one should come up with incentives that will hinder them from enjoying their freedom.

Recently President Barack Obama in the introduction of Obamacare maintained that Americans ought to be made to take responsibility for their health. The health scheme introduced by Obama allows employers to increase the health care costs of smokers (Madison, Schmidt & Volpp, 2013). This system is supported by scholars such as Banzhaf who maintains that increasing insurance premium on smokers will motivate smokers to quit smoking and live a healthy lifestyle while at the same time helping in the generation of revenue for the federal government. However, it is clear that the price of cigarettes is very high due to the high taxation that the government has placed on them. It is evident that the selling of cigarettes contributes to a significant percentage of the government revenues and thus forcing these people to stop smoking may affect the government revenues.
Research has shown that cases of smoking and obese are more prevalent among low-income households. Charging higher insurance premium on people suffering from these conditions would mean that majority of those affected come from low-income families hence raises the issue of actuarial fairness which in the long run will widen the economic gap (Claxton et al. 2013). Although a particular group of people may argue that charging higher premiums may not encourage them to stop smoking, one may agree that even reducing smoking may not save the government any amount of money. Other researches indicate that obese people incur the highest health care expenditures in the age group below 56 years; while among the older people, smokers are likely to incur the highest costs. The research points out that since smokers and obese people are likely to die at a younger age as compared to healthy individuals; the group of healthy people is likely to incur the highest lifetime health care expenditures (Madison, Volpp & Halpern, 2011). In this case, increasing the premium charges to reduce the number of smokers and obese people may not enable the society to save money.
The primary issue with the actuarial fairness arguments entails that various smokers are likely to face different risks in their lifetime. In this case, any person that smokes two or more packs a day for a duration of thirty years is likely to develop lung cancer as compared to those who smoke fewer cigarettes for a few weeks in few years (Pauly, Leive & Harrington, 2015). To make the premium payment policies fair, those policies that have been adopted by the insurers or employers need to consider the rates at which the different smokers take, depending on their personal risks (Leeder, 2015).
Another reason behind charging higher insurance premium on unhealthy living is premised on an implicit social contract whereby the high fee is meant to make society members responsible and make productive contributions to the community (Stegeman, Willems, Dekker & Bossuyt, 2014). However, Dubois opposes this argument maintaining that for such cases to hold, it would require a more comprehensive theory of justice and an ideal society to make it tenable. To strike an appropriate balance, justice considerations that give precedence to the concern for members of society who are least well off should be emphasized (Claxton et al. 2013). Most of those members of society with unhealthy lifestyles come from low-income families hence, charging people with unhealthy lifestyles a higher insurance premium would mean such justice considerations are not considered. This will promote an unjust society where the least well off are denied access to necessities such as adequate medical care (Madison, Volpp & Halpern, 2011).
Imposing higher premium charges on smokers appeal to consideration of fairness and social justice. Such a policy to increase the premium charges of the obese and smokers is likely to make the obese people, and smokers forego the health insurance although they are likely to pay fines under the Affordable care Act (Madison, Schmidt & Volpp, 2013). Since most of the smokers usually earn lower incomes than those who smoke, the smokers are likely to be vulnerable to the increase in the cost of health insurance. Making them opt out of health insurance could create a detrimental impact on their health care access and thus causing an adverse impact on their health. Moreover, different insurers have had plans that cover smoking-cessation programs. In this case, it may be ironical if the insurer charges smokers’ higher premiums that may prevent them from heal care access, which could stop smoking (Leeder, 2015).
Other analysts argue that it is unethical to subject members of the society living an unhealthy lifestyle to the payment of higher insurance premium when the government has failed to implement effective measures to help curb such lifestyles such as raising cigarette taxes as well as banning smoking in workplaces and the public (Rice et al. 2014). Furthermore, increasing the cost of health insurance will in the long run backfire by raising the cost of insurance beyond the available means especially for the low-income earners who in most cases are involved in unhealthy lifestyles and as well make the health insurance unavailable to such people (Madison, Volpp & Halpern, 2011). According to Dr. Ribisl, the move is likely to drive the people living unhealthy lifestyle away from health care systems and subject them to more risks at a time when they need medications and doctors most to assist them to adjust their lifestyles (Pauly, Leive & Harrington, 2015).
In his opposition to the Obama administration policy that advocates for an increase in the insurance premiums paid by those who have embraced unhealthy lifestyles, Dr.Ribisl maintains that charging higher insurance premiums on smokers would imply that smoking is a condition, which individuals can easily control (Rice et al. 2014). He states that nobody is born using tobacco and therefore as much as smoking looks controllable to many; it is not easy to control it. Policies that encourage imposition of higher insurance premium on smoking assume that those who smoke simply wake up and start smoking. However, those who smoke have their own valid reasons as to why they engage in smoking. Most smoking is associated with psycho-social conditions which are not controllable. Therefore, just like insurance premiums on car insurance as well as fire insurance on our homes depend on whether or not we take enough necessary precautions, the premium on unhealthy lifestyle should consider such factors too (Madison, Volpp & Halpern, 2011).
Moreover, some of the unhealthy lifestyle such as smoking is addictive making it difficult for the people who would wish to quit. Charging high insurance premium on such people is quite unfair since they have the desire to quit, but due to their addiction to smoking, they are left with no option but to continue smoking (Gaesser& Blair, 2011). A particular group of people may argue that charging higher premiums may not encourage them to stop smoking; one may agree that even reducing smoking may not save the government any amount of money.
Obesity is caused by multiple factors within the life of a person, such as unhealthy diet, genetic predisposition, sedentary lifestyle and a disbalance in the body metabolism (Cavico, Mujtaba, Muffler & Samuel, 2014). This is why the industry for junk food is prospering all over the world. Moreover, obesity is one of the leading causes of chronic infections such as respiratory problems, diabetes, heart infections and hypertension. The life expectancy of obese people is short, and the insurer keeps this in mind while calculating the premiums. Although obesity does not prevent one from being given an insurance cover, one is likely to pay more for the cover as compared to other ordinary people. Not only will the cover be compromised but also the obese person will have to bear more exclusions on the cover (Claxton et al. 2013). Research has proven that obesity is not just caused by an individual’s eating habits but rather it is based on an individual’s metabolism as well as the genetic orientation of a person (Madison, Volpp & Halpern, 2011). Human beings may have no control over their weight hence charging high insurance premium on obese people on the pretext that they use the health system more often is completely unethical and unfair.
Moreover, an individual’s health status should not be determined based on his or her BMI since having a high BMI does not necessarily imply that the person is unhealthy (Cawley, 2010). Studies conducted by a team of UCLA psychologists and published in the International Journal of Obesity in February observed that over ten million overweight and obese people are in a perfectly healthy condition. Similarly, research conducted and published in the European Heart Journal proved that many obese persons were metabolically healthy as long as they did not suffer from any other health complication such as high blood pressure, diabetes and high triglycerides (Stegeman, Willems, Dekker & Bossuyt, 2014). It is, therefore, unethical for insurance companies to charge the obese high insurance premium on the pretext that they cost the companies more regarding medical attention.
Incentivizing smokers to make them stop smoking is an unjustified move and a paternalistic interference in an individual’s autonomy (Madison, Volpp & Halpern, 2011). Smokers and obese people should be given an opportunity to make their personal lifestyle choices that are free from coercion from their insurers, the government or their employers. Just like imposing more taxes on products such as tobacco, alcohol, and gasoline, increasing the insurance charges on this groups of people does not guarantee that they will stop them from engaging in that kind of behaviour (Pauly, Leive & Harrington, 2015).
According to Mikael Dubois in his Journal of Primary Prevention Paper, charging higher insurance premiums on unhealthy lifestyle would raise thorny issues on similar matters that deviate from the social norm such as genetic disorders, which will, in the long run, be ethically unacceptable. Dubois further maintains that a keen study of the annual medical expenses in any company for the healthy versus the unhealthy will observe that the unhealthy raises the company costs (Leeder, 2015). However, since the unhealthy tend to die earlier in life, their total costs accumulated over a lifespan are equal if not less than the total costs for the healthy members of the company.
Dubois points out that imposing more financial incentives is a good form of cost-shifting. In the event that the capitated health care plans switch the task of controlling costs onto the health care provider, the insurance plans distributed on the basis of health lifestyle pass a percentage of the costs from the insurer to the consumer (Claxton et al. 2013). Also, there are medical visit copayments, which show significant variations with the differentiated insurance plans. These copayments can be applied unconditionally and universally, in contrast to the type of ‘means-tested’ system of levying the various rates depending on the individual’s health status and behavior (Stegeman, Willems, Dekker & Bossuyt, 2014). Moreover, the copayments are a means of discouraging the unnecessary use of medical services and promoting the adoption of sound characteristics.
Other research analysts point out that employers charging their employees who smoke or who suffer from obesity more health insurance should consider giving all staff a chance to qualify for the non-smoker accolade at least once every year. The employer should also provide some smoking cessation programs to all the employees so that they get the chance at the incentive (Cavico, Mujtaba, Muffler & Samuel, 2014). On the other hand, a company should make a decision on whether to permit e-cigarette or occasional smoking and come up with the strategies to discipline any employee who may lie about his or her status about smoking to get the incentive. Employers are required to tread carefully about the move to increase the premium charges to smokers and obese people since they are likely to lose highly qualified employees who may opt to join other companies that do not have this incentive. In this case, the company should consult with its legal department on what steps to take if an employee embarks on the smoking habit (Pauly, Leive & Harrington, 2015). The company should also figure out the level of authority it may have in policing its employees.
Numerous researches have linked obesity and smoking to chronic infections such as cancer, diabetes, and heart diseases. In this case, a person living a healthy life and rarely visits the doctor or the hospital cannot pay the same premium charges as a person who leads a poor lifestyle such as smoking or eating junk foods. People with obesity or smokers frequently visit the hospital due to various complications that are brought by their conditions (Madison, Schmidt & Volpp, 2013). While one may argue that the federal government has no right to decree the people’s lifestyle, there remains an uncertainty that “is there a specific point that an individual is required to take control of his or her health, and should the society espouse financial impetus that may influence the lifestyle of the members of the society?” Although many people have contradicting views about the topic, there is clear evidence that the move to increase the premium charges for obese and smokers is unethical and prevents these people from exercising their rights and freedom. Moreover, the move may infringe the obese and smoker’s rights to access medical care since the increase in the insurance charges is likely to make them abscond from paying the premiums (Cavico, Mujtaba, Muffler & Samuel, 2014). On the other hand, the federal government should also devise better strategies and campaigns that will promote healthy living within the society and reduce the number of people who smoke.
While it may be imperative to encourage people to quit smoking or maintain a healthy lifestyle to avoid obesity, charging them higher premium costs is unfair and may not be an efficient method for achieving the targeted goals. All insurers and employers should review the implication of such policies before adopting them. Any policy that is adopted should be fair to all people and not undermine the obese and smoker’s rights of accessing proper health care (Cavico, Mujtaba, Muffler & Samuel, 2014). In this case, the policies should be accountable for all the individual differences in health risk and may require revision if the established procedures have some unintended negative consequences for the smokers and obese people’s access to quality care.

References
Madison, K. M., Volpp, K. G., & Halpern, S. D. (2011). The law, policy, and ethics of employers’ use of financial incentives to improve health. The Journal of Law, Medicine & Ethics, 39(3), 450-468.
Madison, K., Schmidt, H., & Volpp, K. G. (2013). Smoking, obesity, health insurance, and health incentives in the Affordable Care Act. JAMA, 310(2), 143-144.
Leeder, S. (2015). Public health opinion: Taking a risk on insurance. Australian Medicine, 27(12), 23.
Rice, T., Unruh, L. Y., Rosenau, P., Barnes, A. J., Saltman, R. B., & van Ginneken, E. (2014). Challenges facing the United States of America in implementing universal coverage. Bulletin of the World Health Organization, 92(12), 894-902.
Stegeman, I., Willems, D. L., Dekker, E., & Bossuyt, P. M. (2014). Individual responsibility, solidarity and differentiation in healthcare. Journal of medical ethics, 40(11), 770-773.
Pauly, M., Leive, A., & Harrington, S. (2015). The Price of Responsibility: The Impact of Health Reform on Non-Poor Uninsureds (No. w21565). National Bureau of Economic Research.
Gaesser, G., & Blair, S. (2011). Big fat lies: The truth about your weight and your health. ReadHowYouWant.com.
Claxton, G., Rae, M., Panchal, N., Damico, A., Whitmore, H., Bostick, N., & Kenward, K. (2013). Health benefits in 2013: moderate premium increases in employer-sponsored plans. Health Affairs, 32(9), 1667-1676.Segar, M. (2013). Smoking Insurance and the Cost on Society.
Cavico, F. J., Mujtaba, B. G., Muffler, S. C., & Samuel, M. (2014). Wellness Programs in the Workplace: An Unfolding Legal Quandary for Employers. International Journal of Occupational Health and Public Health Nursing, 1(1), 15-50.