the iron yuppie

My good friend the Iron Yuppie comments on my healthcare post. He brings up an interesting idea - incent people who are a cost burden on healthcare to not be a burden. In his example he suggests that his employer pushes a cost burden down on employees who are out of shape.

In general I like these kinds of ideas. But I actually think it won't work in this case for one simple reason. Apart from outliers (stopping smoking) I don't think the average person has any clue how to improve what kind of shape they are in.

Just yesterday some data was reported on the news that slightly overweight people live longer than normal weight people. Huh?

How about diet? Some people suggest we 'eat in moderation'. Does anyone want to answer what exactly is moderation? Is it 33% carbohydrates, 33% protein, and 33% fat? Is it the diet you would have if you randomly picked items in a grocery store? Is it based on what we have historically eaten during our 3.5 million year existence - namely bone marrow, brains, nuts, and berries? Is it low fat or low carbohydrate? Moderation is meaningless.

How about working out? How much is good? I've heard Tour de France contestants take 10 years off their lives. I've never seen the data so I'm suspect. However, whenever they interview those 108 year old, bright as a whistle grannies, they never seem to have a hardcore work out regimen they follow. Jim Fixx would probably agree with that.

What about genetics? Does that impact what shape we're in? Do we get penalized for our genetics? Presumably not. But how do we separate what part of your 'shape' is genetic based and therefore which part will you be in control of?

This just all seems too hard. I think more efficiencies can be gained by looking at processes in the healthcare. Centralized purchasing for the entire nation obviously gives some of these countries an advantage over even the biggest HMO in the US. What about removing the top 3 expensive procedures entirely? If you want them, you pay out of pocket. I'm sure there is an analysis showing how some part of the system causes an inordinate amount of costs to be incurred.

Anyway I'll pass the recommendation back to Mr Iron that you should subscribe to his blog. He's smart and not as cynical as me.