Time out for a bit of Shmoozing

Thanks for the discussion. Let me exercise my privilege of the host and sum up my own thoughts in response here.

I'm definitely in favor of encouraging healthful behaviors and encouraging people to take care of their own health. For the most part, however, I don't think charging people more for health insurance if they screw up is the best way to do it. The case of obesity is particularly salient since it's a growing, devastating epidemic that threatens the gains we have made in population health. But it's ineffective, as well as misdirected, in my view, to think of it as a failure of personal responsibility. It's a disease that results from the interaction of a genetic endowment shaped on the African savanna, with an environment flooded with low nutritional quality, high calorie density foods and sedentary jobs. The vast majority of obese people desperately want to lose weight, and many of them try repeatedly, and repeatedly fail. Raising their insurance premiums isn't going to solve the problem.

Furthermore, with few exceptions it just isn't possible to determine each individual's behavioral risk profile. Maybe you maintain a perfect body weight, don't smoke, and don't have any obvious risk behaviors the insurance company can use to raise your premiums, but it turns out you drag race on the state highway at 3:00 am every Saturday morning, or have unsafe sex with strangers 3 times a week. It's just an impractical strategy.

It is true that young people today may be at higher risk for poor health than their parents because of prevalent obesity, sedentarism, a drug culture that is in some ways more dangerous than the hippie days, really crappy diets, etc. But the fact is this isn't going to result in poor health until later in life. Their medical expenses right now are still low. To me, this just strengthens the argument that age rating is contrary to generational justice. You may resent paying more than you are likely to cost today, but you will get older, or at least you hope to, and then you'll be holding the other end of the stick. And those folks who are older today are your parents and grandparents and aunts and uncles and teachers, and hey -- you owe them something. You'll expect some gratitude when you get older as well.

On the other hand, if you're just starting out on your career or taking time to do good works as a community organizer or whatever it may be, and don't have much money, fine -- I have always been a very strong advocate for progressive financing. You should pay according to your resources, which would be the case in a tax-funded system, or a system with subsidies such as Congress is working on. (Don't know if they'll be adequate, but the principle is there.) But if you're a hot shot investment banker in your 20s, I say you should pay and pay and pay.