Some time ago, I wrote a cover story entitled “The Fat of the Land,” in which I outlined the clear additional health care costs of our nation’s overweight and obesity problem, and suggested that the health insurance industry had a clear interest in taking action to promote wellness as a means of loss control. The story got some interesting feedback, ranging from those who argued that my suggestion was tantamount to advocating for government control over what we eat…to those who shook their heads slowly at so many Americans’ willingness to eat and overeat to the point of self-destruction. Not long after I wrote this article, I was invited to speak at the Mississippi State University I-Day conference, and I gave a presentation on this same subject. Because my talk got pushed back a bit, it came right after a post-lunch dessert break, in which attendees were fed pieces of sheet cake and ice cream. Needless to say, my presentation on how overweight and obesity is costing this country some $60 billion a year in extra health care costs did not sit well with some in the audience. 

Back when I wrote that article, I noted how the Heart Attack Grill was sort of the apex predator of a trend toward extreme food in the chain restaurant business. (The heart Attack Grill is no longer a chain, really, as it’s down to just one location, in Las Vegas.) Infamous for serving food that is really bad for you (like its 8,000-calorie Quadruple Bypass burger), the Heart Attack Grill lived up to its own name in 2010 when its spokesperson, the morbidly obese Baine Rivers, died of pneumonia, thought to be exacerbated by his extraordinary weight. Later that year, a patron actually suffered a heart attack while dining at the Heart Attack Grill, a story picked up with morbid glee by mainstream media outlets.

But attention on the Heart Attack Grill quickly waned as the public’s attention switched to the next bizarre story of the day; in an era of social media, the half-life for any oddball story is less time than it took me to write this sentence. Still, the Heart Attack Grill remained as a symbol of an ugly truth underscoring so many of the difficulties facing the health care system in general, and health insurance in particular. It is returning to the press once again, since a few days ago, an unofficial spokesperson for the restaurant, who ate theire frequently, had a heart attack right outside of the restaurant door. He later died. And I am sure the restaurant’s owner will express his sympathy over it all, but the guy still seems unlikely to stop selling fries intentionally cooked in pure lard to make them as unhealthy as possible, alongside towering burgers dripping with grease, to be chased with unfiltered Lucky Strikes after. This is his schtick; rebelling against the supposed political correctness of simply taking care of one’s own body. It’s a free country. He is within his rights to do so. But he’s also open to be called out for what he is: a recklessly irresponsible purveyor of harmful products that have, most likely, directly contributed to the death of two people so far and the hospitalization of at least one more. If you sold toys with the same disregard for the health of those who used them as the Heart Attack Grill has toward its patrons, you would be sent to jail. 

Alleman

I recently debated with a friend who did not think that, conceptually, insurance was a means to finance risk. I argued that it was; insurers themselves certainly see it that way, at any rate. With, say, commercial property insurance, if you are buying a policy to insure against fire, there is a real chance that you may never have a fire during the lifetime of the policy, especially if the insurer requires you to employ basic fire prevention measures. In commercial property, you can sell somebody fire insurance and then say the policy might be null and void if you don’t install fire alarms and fire extinguishers at your expense. Sounds a little harsh, but that makes sense. But we do not do the same thing in health insurance. Why not?

I suppose on one hand, insurers really don’t want to tell people how to live their lives. On the other hand, people have shown that they’d prefer to keep a place like the Heart Attack Grill in business. Not everybody, of course – but how many folks regularly eat fast food, knowing full well it’s bad for them? How many people smoke, despite knowing the dangers? Some folks just don’t think. The majority that act like this simply don’t care. In the old days, health insurers overplayed their hand by trying to limit loss control in a way that led to denied coverage and the sort of public outcry that led to the passage of PPACA. But the health insurers had a point: if you’re agreeing to fund somebody’s risk, why not apply some leverage in the deal if the buyer isn’t willing to manage risk him or herself? 

You can’t very well say to an insured these days, “if your body fat gets up over 30 percent, we’re dropping you,” but it can positively incentivize people to pursue healthy behaviors for reward. Some insurers do this already. All ought to. And all ought to be dumping 10 times as many resources into it as they already do, because this country is still the biggest monument to overweight and obesity in human history, and for all of the health insurance industry’s complaining that PPACA puts so many onerous requirements on insurers without really addressing rising health care costs…the insurers themselves could be a much better job of dealing with that. Getting people to embrace health in a country where our food system is rigged to deliver really cheap, really salty, really sugary foods to a public that stopped thinking critically about the stuff it is ingesting is a hard task. Some would say it is impossible. But there is still the matter of $60 billion in extra costs the health insurance world is swallowing EVERY YEAR. Why is that not incentive enough to make wellness a top priority? why are there not health insurers issuing press releases about how sad it is that a place like the Heart Attack Grill still exists? Where is the industry’s courage on an issue it clearly has a stake in and has not yet tackled? Surely it exists. But we have yet to see it.