Yesterday's piece on obesity drew a lot of commenters who had an excellent point.
Denying coverage based on your lifestyle is a lot like the current industry mania about "pre-existing conditions" that began the reform debate.
So how about this.
Smokers already pay more for health insurance. This smoker's differential can amount to up to $50/month.
And this is on top of all the other trips society has for tobaccoholics, from smoking pens in airports to the nasty looks of people like me trying to get out of the way of your smoke trail.
When this first became popular, in 2006, the CDC was estimating smoking cost $92 billion per year in lost productivity and $75.5 billion in direct health care costs.
That's awfully close to the $147 billion cost for obesity, another CDC estimate.
Scientists can measure the cost of your lifestyle choices. Actuaries can build these risks into rates. This is where the health insurance industry is moving, toward the collection of more data on people who aren't sick, evaluation of lifestyle risks, help in minimizing those risks, and penalties for those who ignore the advice.
This is not a question of who pays. The concept is, in fact, moving ahead faster among private health insurers, who have to answer to employers paying your premiums, than it is in government programs.
But at the heart of the savings President Obama promises from health reform is the extension of this regime to everyone. Best practices are driven by data. Wellness programs are driven by data. And the whole idea of that data is to check your compliance with medical advice, to change your lifestyle.
Many of the comments yesterday were on point. But many others weren't. Commenters argued against public health programs generally, charging it was a "taking" from them they resented.
So when a private company charges you more for insurance because you're obese, or because its data indicates you don't comply with your doctor's orders regarding diet, exercise, and wellness, is that a taking? Sure feels like it to me, and it's those who don't get charged extra whom I feel are doing the taking.
In suggesting that certain lifestyles be excluded from coverage due to their cost, I obviously struck a nerve. But there is no difference, in fact, between government refusing care based on your lifestyle and a private insurer raising its rates through the roof on you for the same reason.
Big brother and little brother have the same agenda, which is making sure you do what they say.
Or else. Be as much of a jerk as you want. Just not with my money.