Should Obese People Be Punished?
Sociology 130, Writing Assignment #3, Fall, 2009

Updated August 16, 2009

Write a 3-page paper, taking a definite position pro or con on the following statement: Obese people (people with a body mass index [BMI]>33) should be charged higher rates for their health insurance.

This discussion issue is based on the articles by David Leonhardt, "Fat Tax. Should Overweight People Pay More for Health Insurance?" Pp. 9-10, New York Times Magazine, August 16, 2009, and which you can find on Blackboard. A counter perspective, also on Blackboard, is David Zinczenko, "Don't Blame the Eater," pp. 139-141 in G. Graff and C. Birkenstein, They Say, I Say (NY: WW Norton 2006), both of which you can find on Blackboard.

One of the important questions related to health is whether individuals are actually as responsible for their health as the New York Times Magazine article suggests. We know that education, access to health "trainers" (like doctors but also others), and avoiding life stress has a big impact on health. But there also are societal, cultural, institutional, and community forces that shape health. This is why the social class gradient of disease is such a striking finding.

When you write this paper you will do better if you lay out a philosophical perspective that tells how you think we should think about health issues like this one. Then bring in the specific issues that build your argument and that you think are the most challenging points the opposition has to offer.

The statement you are to write about is based on several core assumptions:

1. The costs of insurance are related to the risk of the people being insured. If you think of auto insurance, the riskiest drivers pay more insurance because they are likely to cost the system more. People are expected to pay ther fair share.

2. Obesity can be prevented if people eat less and exercise more. In that sense it is a choice. Not only might we ask people to pay if they make choices that cost everyone else money. Perhaps, as has been the case with smoking, negative information coupled with restrictive regulations will convince people to change their behavior.

3. Obesity affects the children in a family, not just parents who buy health insurance. It is important for parents to give their children good nutritional and exercise information and to lead by example so that the young will be socialized into more healthy life styles.

4. Obese people have higher health care costs than non-obese people. If we are trying to lower health care costs, maybe we need to have a population with a healthier life style.

This list probably is not exhaustive. Look for other arguments!

Critics would argue that most of the core assumptions that support the argument that obese people should pay more for health insurance are wrong.

1. Health insurance is not like automobile insurance since rather that setting insurance rates in response to risk we try to insure pools of citizens. The idea is that healthier citizens in an insurance pool do not cost the system much money and so they pay for the sicker people. If we start insuring people based on their personal risk then we will only insure those people who are healthy and do not need insurance and the number of uninsured people will grow.

2. Obesity is actually not clearly related to ill health (at least at moderate levels—our level of a BMI > 33 is pretty high so maybe this doesn't apply). Ill health is more related to lack of exercise and obese people don't exercise much. If they do exercise they're healthier but they still would be punished.

3. The Body Mass Index is a good general measure but it is inaccurate as a measure of obesity when applied to many specific individuals like football players, weight lifters, and other people with lots of muscle mass relative to their height. There would have to be a more complex and individualized measure for it to be fair to punish people for being heavy.

4. People with a high B.M.I. tend to have lower incomes than thinner people. These individuals already pay for being fat, according to Leonhardt's article.

5. If we punish people who are overweight would we also try to punish others who behave in self-destructive ways like heavy drinkers? Sky divers? People who have lots of sexual partners?

6. Obesity is related to geography and access to opportunities to work out and eat well. Inner city neighborhoods are dense with fast food restaurants and have few supermarkets. They also do not have cheap, accessible places to work out.