Who's your health nanny?

Big Government or Blue Cross Blue Shield?

More likely the latter, I think.

In order to receive full 80-20 health benefits through Blue Cross Blue Shield, this year NC state employees (including yours truly) had to sign a waiver that they didn't smoke or had enrolled in a smoking cessation program sponsored by a doctor.  Otherwise, employees received lower 70-30 coverage rather than the standard 80-20.

There will be random testing of those who claim to be nonsmokers.  Those who test positive for smoking will be punished, losing all co-payments for care already received in that year, switched to 70-30 coverage for the remainder of the current year, and kept at 70-30 coverage for the following year regardless of whether they quit smoking or begin a smoking cessation program.

What's next?  A neighbor tells me that next year those with a BMI above some threshold will receive less coverage too.

This, I suspect, is just the beginning.  As health costs escalate and exclusions based on pre-existing conditions vanish with implementation of the new health bill, insurance companies may need to think more creatively about ways to lower costs.  And the cheapest way to lower costs may be to target prevention. BCBS will have strong incentives to figure out that illusive diet that really works.  They may even bribe food companies to make food that's really healthier. Maybe they'll pay people to exercise.  Insurance companies could be more intrusive (and effective) nannys than government ever could be.

So is this a good thing or a bad thing?

Update:  I really don't mean to pass judgment on this, just point out some interesting tradeoffs.  Actually, I find a fair amount of irony in all of this.  You see, a "nanny state" is one of the right's biggest fears.  But I don't think a government run health care system would be able to play nanny nearly as effectively as BCBS.  At the same time, I think having BCBS play nanny might do more to reduce costs in the long run than would having a government-run single-payer system that is coveted by the far left--maybe not now or the next five years, but eventually.  So, something here to irritate both the left and right of the political spectrum.


  1. As much as I am against smoking, I find hard to believe BCBS won't thrash the bushes for new reasons to control policy holders lives! A smoking ban in public places is one thing restricting lifestyles right or wrong is against the law. BCBS is merely jumping on the band wagon while it can. You are right to be concerned, if your gay are you going to need aids treatment, if you enjoy sports are you more likely to break something. BCBS does have a stop smoking program of which I applaud, but maybe it's a ploy to search out smokers and punish them.


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