In case anyone’s wondering, let me say this right up front. I’m 100% in favor of universalizing access to healthcare in America, as they’ve done in all other developed nations long ago. I also salute any attempt to refocus our broken healthcare system on prevention and wellness instead of disease and rehabilitation in order to maximize profits as is our current practice. Anything less is un-American, un-Christian, and immoral.
But that’s not to say that the Affordable Care Act (aka the ACA or Obama Care) is beyond the need for tweaking and polishing. Therefore, the following comments represent an attempt to tweak and polish the ACA (which scheduled to go into effect 8/1/2013) and not to undermine it.
More specifically, in its attempt to tackle the 21st century obesity epidemic the new legislation requires employers to identify obesity in the workplace by using Body Mass Index (BMI), and to take actions designed to reduce obesity by encouraging (providing incentives for) employees to reduce their respective BMI scores.
Problems Lurking on the Horizon
The problem is that BMI has accuracy issues. Due to its well documented inability to distinguish between body fat and muscle mass (the only two factors that count when it comes to obesity) BMI has become very controversial in recent years.
There are conventional alternatives* such as hydrostatic weighing, bio-electronic impedance, and the skin fold method. But all of them are significantly more labor intensive (i.e. expensive to implement), so BMI has been granted its chosen position by virtue of default, not merit. On the other side of the coin, going cheap on the front end has proven to be extremely expensive on the back end, as witnessed by insane increases healthcare costs over the past decade.
So what kinds of problems are on the horizon when the ACA requires employers to use BMI to identify obesity in their employee ranks? For starters, lawyers are destined to have a litigation field day defending their clients (whether corporations or labor unions) against a law that mandates the use of a provably problematic metric to address America’s number one health threat – obesity - in the workplace.
Health Insurance Premium Gouging
The second problem is that requiring the use of BMI will provide health insurance companies with a golden opportunity to charge ever more excessive premiums based on an extremely questionable metric. Want proof? The average NFL player’s BMI is 31.35. The average NFL running back’s BMI is 31.35. And the average linebacker’s is 30.98.
According to the conventional lore obesity is defined as 30 BMI and above. So based on BMI the average NFL athlete is obese… despite the fact that most of their actual percentages of body fat are relatively low. Insurance companies will take full advantage and make out like bandits thanks to BMI.
The Crying Need for a Metric That Works
In other words, there's a crying need for a metric that’s both affordable up front, and accurate in terms of body composition feedback - which makes it affordable on the back end. Interestingly enough there is such a metric that’s currently available just for the asking. It’s called a FORE Score and with the stroke of an executive order from President Obama, this potential fiasco in the making could be prevented before the law goes into effect in another month.
Prevention, as they say, is always better than cure, and the new Affordable Care Act is no exception to the rule. I personally want the ACA to succeed and benefit Americans across the nation. To the President I simply say “Let’s Tweak, RIGHT NOW!”
* To be totally honest, the other three have accuracy issues of their own.