There’s been an awful lot of talk lately about CVS and their recent decisions regarding health care for their workers. It seems that CVS has implemented a policy that states that employees have a choice between submitting to a health screening or paying $600 more per year in health insurance premiums. The screening (paid for by CVS) will measure several “health metrics” including blood pressure, blood glucose levels, cholesterol, height, weight and BMI. Apparently this information will then be turned over to a third party. What we don’t know is what the third party plans to do with this information and how the third party and/or CVS will use this information to help their employees be any healthier. I submit that helping employees be healthier really has nothing to do with it.
Look, if you want to give your employees incentives to see their doctors twice a year–fine. Regular checkups with your doctor make sense. They help employees manage health and catch problems early. But I can think of no reason why handing this information over to anyone other than your own doctor will do anything to improve your health. Not one.
The only reason to hand this information over is so that a company–be it CVS or a mysterious “third party company” can start harassing you for being in a “higher risk” category. That harassment may come in the form of emails or phone calls. That harassment may come in the form of additional payments you need to make as long as you stay in a “higher risk” category. And believe me, the quotation marks are deliberate when I say “higher risk” category.
Every single one of these metrics has a strong, and I mean STRONG genetic component. They are not measures of behavior or lifestyle. They are statistics about bodies. Lifestyle may be a component of having diabetes in some people. Some people are simply born with a very high disposition to diabetes. So you may have two people, one diabetic and one not who engage in extremely similar lifestyles with very different outcomes. The same is true of cholesterol levels and blood pressure. So how is this not a Gattica style punishment of people who were born with less than perfect genes? How much longer before, like in the movie, we will be forced to leave a drop of blood in the scanner before starting work every morning?
And then there’s the question of collecting height, weight and BMI data. Despite the overwhelming evidence that BMI, height and weight do not serve as accurate measures of personal health, we are still collecting this data. Why? I’ll tell you why. Because fat people are discriminated against in this country. Fat people are blamed for everything in the US from rising health care costs to rising prices on airlines. If you have to look to a socially acceptable scapegoat on which to visit higher health insurance prices, you will choose the fatties. Don’t believe me? Just check out the comments section of any news story covering this decision by CVS. They are universally full of righteous thin people talking about how those fatties are driving everybody’s costs up and deserve to be punished “for their own good”.
Some argue that insurance companies already charge smokers more money. But let me be very clear about this. Smoking is a behavior. You can choose to smoke or not to smoke. You don’t need to smoke to survive. Weight and BMI are characteristics. You CAN NOT determine what a person eats, how much they exercise or how healthy they are by looking at their BMI. All you know is the proportion of their height to their weight, and the proportion of extra costs and stigma it is socially acceptable to heap upon that person.
Other risk behaviors are notoriously expensive and difficult to monitor. Behaviors like drinking, not sleeping enough, distracted driving, uncontrolled stress, not looking before you cross the street and skydiving cannot be measured with a 10 second test in a doctor’s office.
So to reiterate, why are we using weight and BMI to measure a persons health risk rather than behaviors?
1. Unless you actually watch a person or test a person all the time, it is difficult to know whether they are telling you the truth about stated behaviors.
2. BMI and weight, while poor proxies for real data about health require only extremely easy and inexpensive tests to determine.
3. It is socially acceptable in our country to blame fat people for anything and everything.
This is why I will no longer shop at CVS. They have chosen to pass insurance costs on to those who may or may not engage in higher risk behavior than their co-workers but are probably less genetically blessed than their co-workers. And they are already passing health care costs on to those of us who are already discriminated against when seeking a job and are already payed less than those of us who are thin. It’s not okay with me.
The Fat Chick