No Matter Who You Are Shining Bright

This fresh hell is the oldest trick in the book.

North Carolina is poised to become only the second state to impose a fat fee on its state employees by placing them in a more expensive health insurance plan if they're obese. Smokers will feel the drag of higher costs, too, as North Carolina state employees who use tobacco are slated to pay more for health insurance next year.

North Carolina officials, coping with a steady uptick in health care costs for state employees each year, are aiming to improve state workers' health, which saves money in future medical expenses.

"Tobacco use and poor nutrition and inactivity are the leading causes of preventable deaths in our state," said Anne Rogers, director of integrated health management with the N.C. State Employees Health Plan. "We need a healthy work force in this state. We're trying to encourage individuals to adopt healthy lifestyles."

No, you're punishing fatty fat fatties and bad kids. In point of fact, 100% of state employees will suffer death. If Ms. Rogers were a little smarter, she'd realize these demographic groups are - nyuk! nyuk! nyuk! - cash cows as far as the pension system is concerned. No retirees? Ka-ching!

State workers who don't cut out the Marlboros and Big Macs will end up paying more for health insurance. Tobacco users get placed in a more expensive insurance plan starting next July and, for those who qualify as obese, in July 2011.

Nope, nope. Still going to die. The insurance company is probably a wholly owned subsidiary of Phillip Morris and McDonald's. Sure, there'll be a few surgeries to underwrite, some chemo and prolonged hospital stays, but since insurance companies have an almost magical ability to profit if customers live or die, why not hand out cartons of unfiltered cigs and coupons for Quarter Pounders and stack the deck? Come on, Big Insurance! Let's get it the fuck ON.

Some state employees, though, are criticizing the planned changes. The State Employees Association of North Carolina opposes the tobacco and obesity differentials as invasive steps that could have been avoided if the legislature had fixed the plan.

"It's my understanding they're talking about testing (for tobacco use) in the workplace which, to me, would create a hostile environment," said Kim Martin, a sergeant at Piedmont Correctional Institution in Salisbury. "And it's an invasion of privacy. This is America, the land of the free. I don't think (body mass index is) a very good measure. I know some folks who would have a high body mass index because they're muscular."

Body Mass Index is actually a very crappy measure because it assumes everyone has the same bone structure, same muscle density, same genetics, same diet, same habits. None of that is true. It's even a lie that drugs treat everyone. Hey, I liked Seldane but it apparently killed people who weren't me. Woohoo! Lucky me! Well, except that I can't have the only allergy medicine that ever worked for me because a few lightweights clutched their chests and keeled the hell over. Weaklings. Anyway, about the BMI: here's your calculator. Hold onto that thought, we're going to come back to it.

The idea of penalizing unhealthy lifestyles and rewarding healthy conduct is hardly new among insurance plans. Public health insurance plans in other states already penalize smokers or reward nonsmokers in insurance costs. South Carolina's state employees health plan is scheduled to add a $25-per-month surcharge on smokers in January. Elsewhere in the southeast, Kentucky and Georgia impose surcharges, and Alabama gives non-smokers a discount.

Alabama was out front on weight testing. Starting in January, state workers will have their blood pressure, cholesterol, glucose and body mass index checked by a nurse. If they're in a risk category, such as a body mass index of 35 or greater or a blood pressure of 160/100 or greater, they are charged an extra $25 per month on their insurance premium. If they go to a health screening, either offered by the state or by their personal physician, then the $25 is subtracted, according to Gary Matthews, chief operating officer for the Alabama State Employees Insurance Board.

North Carolina will allow state workers with a BMI of up to 40 to keep the discount, although a BMI of 30 is considered obese by some experts.

Fat people know they're fat. There's absolutely no need to consult an expert. Further: that health screening thing. What is that? You go sit in a trailer parked outside your facility. Someone takes your blood pressure, tells you you're fat and takes $25 off your insurance premium? What does that even mean?

Only a fraction of employers, though, offer financial incentives for healthy behavior or wellness programs, such as gym memberships or smoking cessation, according to a Kaiser Family Foundation study last year. Differences in employees' education, health literacy and access to basic health care could affect the usefulness of financial incentives in reducing health care costs over time, the study said.

The results are not yet in. The higher costs for smokers and the obese don't appear to have been in place long enough for any state to boast of a healthier work force yet, according to officials in several states.

"I don't know that any states have a lot of hard data on this," Rogers said.

And none will because punishing fat people and smokers is not intended to improve anyone's health. It is intended to divide clients into groups that will resent one another and to divert attention from the deeper truth: if we had a national health system, none of this would be necessary. If health care were the point, we would not be seeing divide and conquer. The point is that profit is most easily made when our common interests are obscured.

So let's go back to the BMI, which is as bogus a metric as it gets. We'll use me as a handy example of how this thing fails. Okay? Okay. My weight fluctuates within a ten pound range, but at the moment, my BMI is 28.9. By this standard, I am overweight. Sure, I'd like to lose a few pounds but they won't stay off because I'm a 46 year old woman. I exercise every day. In the last year, I've skipped a total of eight days. I eat two meals a day, drink lots of water, bicycle to work in good weather, eat a diet that would make nutritionists turn cartwheels, and take very good care of myself. I drink wine. So sue me. Anyway, none of that is important because 28.9, bitchez!

At the time this picture of me was taken, I was probably 16. I did 250 pushups a day and just about the same number of situps. I had and used my own chinning bar. In fact, I had and used one until I was just about 40. In this picture, you can clearly see that I was well-toned and in good shape, but not thin. Insurance charts said that someone of my diminutive stature should weigh 105-108 pounds. Even anorexic, I could never get below 119, and it was a struggle to stay close to 125. As Siobhan says when I mention my weight, "What, are you made of mercury?"

So here I am: a prime example of the BMI's shortcomings. So how do we measure health? How about we stop doing that to punish each other? How about we offer everyone health care, offer people dental care? Stop whining that someone undeserving might get something they don't desertivity deserve and concentrate on how it would change our own lives if we didn't have to worry anymore, and if the people around us didn't have to worry anymore, and if everyone had the resources to take care of him/herself? EVERYONE would be sick less often. EVERYONE could care for children and aging parents properly. EVERYONE would not have to face bankruptcy over medical bills. EVERYONE would have a better life. Even you. Especially you.

Crossposted at Brilliant@Breakfast.