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Why we should carry that weight

Date

Annabel Crabb

The world of Extreme User Pays: It starts with higher premiums for fatties, and ends with higher school fees for stupid kids, and a beauty-parlour loading system for the ugly.

The world of Extreme User Pays: It starts with higher premiums for fatties, and ends with higher school fees for stupid kids, and a beauty-parlour loading system for the ugly. Photo: Jenny Evans

Of all the fears presently jostling for position in the federal budget mounting-yard (fear of expensive petrol, fear of a disappearing public service, fear of dispossessed street urchins roaming a Cormac McCarthy-style post-budget landscape pockmarked with dead hospitals and burned-out apartment towers and fighting each other with sharpened sticks), Fear Of A Fat Planet is not even in the top 10.

But a recommendation – from the National Commission of Audit – that would clear the way for health insurers to charge higher premiums to fat people is nonetheless a highly intriguing sign of things to come.

The argument goes that an obese person almost invariably is a bigger health risk than a non-obese person, and thus should declare their fatness when taking out a policy. Insurers already are allowed to ask about smoking; if a pack-a-day smoker is obliged to pony up higher premiums, then so should a bucket-a-day KFC patron, right?

Here we enter the new and exciting world of Extreme User Pays. At the heart of it is the view that people who draw disproportionately on services should be asked to contribute more. It starts with higher premiums for fatties, and ends with higher school fees for stupid kids, and a beauty-parlour loading system for the ugly.

There is a lot of interest in this concept in the airline industry, one courageous corporate member of which – Samoa Airlines – has already started charging higher fares for overweight passengers. In the US, several airlines employ a ''rule of tum'' to the effect that anyone requiring an extender seatbelt should actually purchase a second seat.

Of course, if we were serious about all this, it would make sense to institute a far more extreme scale of fares for air travel. A 50 per cent loading on snorers, for instance, or people who board early so as to cram the overhead lockers with their bajillion bags. A thousand-dollar spot fine for those lunatics who think it's reasonable to recline their seats on domestic flights.

But fare-hikes for fatties are just the slender end of the wedge in this age of too much information.

Health and life insurance used to be a national form of gambling; your hard-earned premiums, wagered against the great unknowns of life, like whether that nasty persistent cough really is nothing at all, or whether the dicky heart that killed your dad turns out to be a hereditary thing. It's a very particular form of wager, in which losing the bet – paying out all that money in premiums and never claiming anything back – actually means you won.

But in the age of megadata, the capacity for the dice to be loaded is unprecedentedly high.

Just think – in the old days, the gamble an insurance company took on you was a generalised bet, based on population-wide estimates of how likely an average person was to get cancer, fall off their bike or require a knee reconstruction.

Big data changes that. Now that you can lick a Paddle Pop stick and have some laboratory email you your entire genetic destiny, including a precise estimate of how likely you are to go mad and commit suicide by cop at age 46, it's not so much a gamble any more as an asymmetry of knowledge. How much should insurers be allowed to know, and for what should they be allowed to charge? The distinction proffered by insurers is that risky behaviour (like smoking or overeating) should be penalised, not genetic risk factors. 

Which brings us to the most intimate question of all: To what extent does a human being author his or her own ruin? Is fatness a fault? Obviously, there are often things you can do about fat. You could have something very strange done to your insides and then drink broccoli shakes, like the Treasurer. You could restrict yourself to a tisane of Chinese herbs, like Malcolm Turnbull. You could develop a sumptuously-detailed eating disorder, like Bob Carr.

But human detail is always messy, close-up. I can understand the complaints of the structurally-diddled – the fitness fanatics who subsidise the couch potatoes, the non-drivers who pay for roads, the childless couples who cough up for schools – but am always reminded of diners quibbling over who had the salad.

Life isn't fair. People get run over, bullied, overlooked, punched by random idiots, held up. They lose children to awful diseases. Their houses burn down in bushfires. They get cancer. None of it is fair, and even those of us who piously bemoan the fact that we subsidise the liabilities of others are only ever one bad holiday food-order away from a squillion-dollar Medevac drama; only one car accident away from an economy-sapping stint in intensive care.

Being part of a society is the best insurance there is.

Annabel Crabb is the host of ABC-TV's Kitchen Cabinet.

0 comment

  • The overly obese with related heart disease, diabetes and additional costs for oversize beds and other hospital equipment should be considered to pay the additional costs they have created, just like smokers. It is not fair for those not abusing their bodies to cover those that are.

    Commenter
    Geoff
    Date and time
    May 11, 2014, 4:20PM
    • And the thin who get sick - let's make them pay too - and let's be particularly brutal on those who have a mental illness - and if they took drugs and are now permanently mentally ill - let's put them on an island and let them fend for themselves. You sound like you are trying to get Tom Elliott's job on radio with that.

      Commenter
      the Truth
      Location
      Melbourne
      Date and time
      May 11, 2014, 5:00PM
    • @Geoff - such an easy solution. Yep, I admit it, I'm obese. But in my case, and many others like me, this is something driven by more than constantly eating fast food - such as you obviously believe. I have been taking anti-depression medication for some time, and I am one of the 'lucky ones', where the medication makes it exceptionally easy to put weight on and next to 'impossible' to get it off, no matter the exercise that I do (and I have and do exercise) or the diets (and I have and do try various). Now, I can stop the depression medications and then I'll become 'healthy' - no, actually I'll just lose weight, I'll actually be far more unhealthy because of the depression.
      Not everyone who is overweight has 'created' the situation - as you obviously believe, some end up that way because of other factors (mine is just one). Should I be forced to pay more because I have depression, which makes me overweight?

      Commenter
      Dee2
      Date and time
      May 11, 2014, 5:02PM
    • The snorers and the people reclining their airplane chairs are notadding any cost to society AC.
      If you believe so much in the rights of the people that make bad decisions andadd cost to society putyour hand up for a 20% do gooders levy. Oh no notforyou you want other people to pay for your beliefs. Union members for your political party and the average taxpayer who supports turning back the boats topay for YOUR political voice inthe ABC. When will you latte lefties start paying for your own beliefs ?

      Commenter
      ig
      Date and time
      May 11, 2014, 5:07PM
    • I think you missed the point Geoff

      Commenter
      structurally-diddled lol
      Date and time
      May 11, 2014, 5:15PM
    • I would suggest, with an increasingly obese civilization, that hospital beds and airline seats be redesigned. They are obviously too small for a great number of the population. We should also introduce a levy on tall people whose presence means that ceiling heights are unnecessarily high. If we were all five and a half feet tall, just think of all the money that could be saved on bricks and glass. We'd be loaded!

      Commenter
      Emerson
      Date and time
      May 11, 2014, 5:16PM
    • The problem here is called "moral hazard".

      Our health system basically makes no-one responsible for their lifestyle choices (moral hazard).

      The best solution would be to privatise the system and let people purchase their own health insurance and life insurance. That way people can lard up and incur all the attendant costs but the rest of us don't have to pay for it. Insurance companies can tailor the price to the attributes of the individual.

      Commenter
      Bender
      Date and time
      May 11, 2014, 5:21PM
    • Your approach is predicated on the generalisation that fat people are lazy.

      Unfortunately there are many factors including allergies, genetics, medications and mental illness that cause obesity and a simple blanket view that laziness and "abuse of their bodies" is just ignorant.

      As is a sense of self entitlement in those who assume that everyone starts equal and those who succeed just work harder and shouldn't have to help their fellow man. That is just not true, just look at the US.

      Commenter
      MJH
      Date and time
      May 11, 2014, 5:27PM
    • There's considerable evidence that no matter who you are or what your health conditions, 90% of your lifetime healthcare costs are going to be incurred in the first and last year of your life. So maybe we should charge babies and knock people on the head as soon as they have something life-threatening. Makes financial sense, but no other kind.

      Commenter
      LS
      Date and time
      May 11, 2014, 5:47PM
    • I see Annabel is positioningherself for a go at the PM job next election
      protector of the 7 sins

      glutony... you have the right to be fat and we will tax the richto pay for it
      sloth... you have the right to be lazy and we will tax the rich to pay for it
      wrath... you have the right to break the laws and we shall tax the rich for your rehab
      lust... you have the right to sleep around and we will tax the rich to pay for your STI/TOP
      envy... you have the right to want other peoples money and we will tax them for you
      greed.. you have the right to make money and we will tax you
      pride.... you have the right to be proud because you are a waste to society but are beingfully paid for doing nothing

      Can't lose Annabel talk about keeping everyone happy except the rich. But 6 out of 7 is not bad.

      Commenter
      abc
      Date and time
      May 11, 2014, 6:14PM
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