The Set Up

Attached above is the last page of the June 2010 issue of Money Magazine. If you can’t see clearly, the question posted at the top is “Should health insurers penalize people for their unhealthy behavior?” Take a second to look over the page, or please refer to it and follow along as you read this post.

Let me start by asking my own questions in reply to this question (a classic Talmudic technique) that I’ll address more thoroughly below?

~ Why are health insurers now not only judge and jury but also executioners? Simply because they’re the only ones who can inflict punitive measures monetarily?
~ Who is determining what constitutes unhealthy behavior?
~ How can we accurately evaluate if people are engaging in these “unhealthy behaviors” and therefore punish them justly, so to speak?
~ How do we make sure to punish everyone engaging in these “unhealthy behaviors” and not just a select few who visually exhibit a perceived relationship to said behaviors?

What interests me most is the way this page provides examples of what it considers “unhealthy behaviors.” These are listed at the bottom. The first is “adults who smoke,” or smoking, and the second is “adults who are obese” or . . . well, “adults who are obese.”

Grammatical, Semantic and Logistical Problems

As the last paragraph may have made clear, the phrasing, “adults who smoke” is forced, and done to coincide with the phrasing “adults who are obese” - but I’m not going to let that slide. Why? Because “adult who smoke” is not an unhealthy behavior. The unhealthy behavior is “smoking,” a gerund (or, verbal noun), which refers to an action or -ing word; as in, the act of smoking, or, the unhealthy behavior of smoking.

Similarly, but more significantly, “adults who are obese” is not an unhealthy behavior either. Obese is an adjective, as in, “He is obese.” However, it’s not a gerund or action or -ing word. I don’t know anyone who is obesing. I know plenty of people who are fat, or “obese,” if we must use the word, but again, that is not an unhealthy behavior. It is their bodily state.

The Classic Health Insurance Shortcut

I believe that Money Magazine is taking a predictable “health insurance shortcut” by saying that all obese people engage in unhealthy behaviors. After all, sofa-lounging gluttonous face-stuffing of McDonald’s is the only reason that people become fat, right? Of course! So, Money Magazine, like our thoughtful insurance providers, thinks, “Let’s just look at obesity as an indicator of unhealthy behaviors.”

Since one stupid move begets another, what we get on this page is an illogical presentation of “unhealthy behaviors” phrased as descriptive nouns of adults, as in “adults who _____.”

The unfortunate result, though, is something that people gloss over casually, thereby reinforcing the public’s prejudice that “obesity” is an unhealthy behavior.

I won’t pretend like getting fat can’t be the result of what are considered “unhealthy behaviors,” but there’s no doubt that the illogical classification of “obesity” as an unhealthy behavior and the very essence of all “obese” people as living, walking (or probably sitting, in the minds of people picturing this), existing unhealthy behaviors in human form is extremely damaging on a large scale.

What Happens When We Allow “Obesity” to be an Unhealthy Behavior

When we allow obesity, as a shortcut to identify unhealthy behaviors, to actually be an unhealthy behavior, we get two major problems (among others), one based on “what about everybody else” and one based on the comparison to smoking.

What About the Non-Fatties

People other than fatties are engaging in the unhealthy behaviors that sometimes lead to being fat. That is to say, based on the illustrations in Money, eating hamburgers is an unhealthy behavior, and the implication is that people who eat hamburgers become “obese.” But don’t skinny people eat hamburgers? After all, I’m skinny, and I eat a lot of hamburgers. How does my insurer know to punish me for this “unhealthy behavior.” I have, after all, been a very bad boy.

Thus, if this question is really about punishing those engaging in unhealthy behaviors and not just milking the fatties for some extra cash, then we’re neglecting all those skinny people eating poorly and not exercising. Looking at their bottom line, health insurers are insuring a lot of skinny people who are visually not engaging in unhealthy behaviors but who will cost them money with medical issues resulting from latent unhealthy behaviors. And they’re not punishing these people! Oh, no!

This issue is akin to the Michelle Obama Anti-Childhood Obesity problem. By focusing only on the fat kids, we neglect to improve the health of the skinny kids with unhealthy behaviors (which, in my unscientific estimation, is most of them).

But Now We Can’t Compare to Smoking!

Moreover, if we accept that we’re discussing states caused by unhealthy behaviors (i.e. “obesity”) as our criteria for routing out those who engage in said behaviors, then “adults who smoke,” by comparison, becomes that current state (perhaps “smoking adults” works better) and the unhealthy behaviors are those things that lead to becoming a smoking adult.

The question then becomes, in the same way that we had to think, “What makes us obese? Answer: Hamburgers,” “What makes us smoke?” The first thing that comes to my mind, funny enough, is high school, or peer pressure (isn’t this also the environment that results in more unprotected sex than most, college included?). The second cause that leads to smoking, again, in my mind, is stress. Why? Because people use smoking as a way to relax.

But Then What?

High school, friends and stress become the unhealthy behaviors that need punishing. Maybe we’d be surprised at how each of those things could be thought of as an unhealthy behavior, but for the sake of progressing with a logical argument let’s isolate the one thing we can probably all agree on as unhealthy: stress, which can cause migraines, panic attacks, insomnia, eating disorders, heart attacks, further reckless behavior like drugs and alcohol, and much more.

Should insurer’s be punishing us for the unhealthy behavior of being stressed, or “stressing” as our aforementioned grammatico-fest would require? Stress is, when we boil it down, caused by life, after all - by being a member of our society.

In fact, being a member of society, according to the insurance provider/Money Magazine shortcut, is what makes us obese also; i.e. fastfood available to excess in our society and the lack of required movement, etc. - a “sedentary lifestyle” - leads to “obesity.” We eat “bad” foods and we smoke because those things are soothing and enjoyable in our otherwise stressful lives - or maybe, for many, in lives that don’t afford us luxurious, organic and whole foods - stressful lives that result from being human.

So Should Insurance Companies Punish Us for Unhealthy Behaviors?

Once we set smoking and “obesity” on a level playing field to compensate for the initially foolish conceptualization of this Money Magazine page, we have to rethink what’s going on here. Doing that allows us to arrive at an answer to the question with which we, and the page, began.

No, insurance companies should not be punishing people for unhealthy behaviors. I will set aside all the personal freedom arguments because insurance is a business (America’s biggest industry, actually), and turn only to the logical ones.

As this page indicates, it’s quite difficult to actually figure out what constitutes an “unhealthy behavior.” Sure, we look at smoking and nearly everyone, including smokers, agrees: smoking is an unhealthy behavior. But what about the things that cause us to smoke, like stress and peer pressure? Should we make efforts to combat those things at their cores to eliminate smoking later? Is smoking more of an unhealthy behavior than stress(ing) is, and how can we actually identify some of these behaviors?

In addition, how do we avoid punishing the people who aren’t engaging in unhealthy behaviors but whose “state” appears as though they are (by this “shortcut” logic of course)? The answer, if we’re using shortcuts to discern unhealthy behaviors, is that we can’t! All the more reason that we shouldn’t go punishing people.

Finally, how do we make sure to punish enough people? If we’re using later stage “state” markers to identify practitioners of unhealthy behavior, then we’re missing all those people who are sedentary and gluttonous but not fat!

There are so many more things wrong with this page that I have to set aside for a long-ignored stab at brevity, and I invite you to share what you notice in the comments, as well as other things I left out about what’s wrong with the logic of the page. I look forward to hearing your thoughts!

As an historian, Jay understands the degree to which our aesthetic judgments are shaped by our cultural surroundings, and he has studied and written about the importance of rights, respect and acceptance for all people. Jay is a member of the Association for Size Diversity and Health.