Insurers and employers cannot change our lifestyles or make us exercise

A Wharton professor of risk management, Scott E. Harrington,  writes in today’s Wall Street Journal that health insurers should be allowed to cherry pick healthy enrollees and should be encouraged to give their enrollees financial incentives to eat right and exercise.

Nonsense. Harrington’s attack on community rating and advocacy of medical risk rating of individuals parrots the health insurance industry’s party line, and he’s just wrong. The literature on preventive and wellness care is coming around to the point I’ve been making for years. That is, other than prenatal care and some screening for cancer and heart disease, most preventive doesn’t work, and it doesn’t contain health care costs or expenditures.

Financial incentives in the form of lower premiums for healthy people can’t change lifestyles. Even bariatric surgery, which makes the stomach smaller and initially helps people lose a lot of weight, can’t change a person’s eating habits. You have to be born with the right genes and luck to be a person who eats right and loves exercise.

If you’ve had or know someone who’s had bariatric surgery in the last seven or eight years, you know that financial incentives don’t change behavior and that many overweight people are obese because of their genes. You also know that while bariatric surgery is beneficial, over time, the benefits wane and weight returns. Surgery doesn’t change eating and lifestyle habits for many people. I happen to know a bunch of people who’ve gone through this, although I haven’t.

The idea that employers or insurers can design benefits that change lifestyles is simply absurd. Yes, initially, people will respond to an employer’s wellness program, but sooner or later, they fall off the wagon.

What drives people to healthy lifestyles is their desire to be healthy and live longer, more functional lives. Those are strong motives, but almost everyone falls off the wagon many times over their lifetimes, and no good intentions or financial incentives will change that.

What the professor, who apparently is good with numbers but knows little about lifestyles or human nature, is missing is that lifestyles are beyond the grasp of employers and insurers. Their incentives are too remote to have an effect.

I strongly oppose the public option and Kennedy’s HMO-style cost containment barriers to access to care.

But I do believe that community rating, which is what Harrington is writing about, makes a lot of sense. The young pay more while they’re young and healthy and less than they otherwise would when they’re older and less healthy. These would be easy reforms to implement along with mandates that everyone buy insurance in the individual markets, not in the group markets.

HIgher taxes on sugar, corn syrup and other fatteners would cause the makers of foodstuffs and soft drinks to use healthier ingredients, but slightly higher prices probably wouldn’t dampen consumer demand much. And the sugar and corn lobbies won’t let it happen anyway.

More important, fix our education system so that people learn to make better financial and lifestyle decisions. You have to get kids to like exercise and healthy lifestyles very early in life, but you can’t do that when schools sell kiddies banana cream pies and other fattening foods.

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