For the last few years, the government and some health insurers have tried to be nice. They have exhorted us all to stop smoking, eat less, and get exercise. The government has spent huge sums on promoting health awareness, but we are now the most obese country in Europe.
Part of the problem for government is that with cuts, fear over jobs and all the rest of the doom and gloom that television and newspapers insist on forcing down our throats daily - we have stopped worrying about the future as the present is tough enough.
Few insurers have attempted the approach of encouraging healthiness, and those that have may have often confused their message by complexity. The public is not convinced by the approach, and reverts back to looking at bottom line price. However much we may sigh and say they need better educating, in tough times price is king and queen.
Some doctors have hinted that they will not treat people who refuse to look after their health, but this is controversial.
For company health insurance, an increasing number of employers offer wellness benefits and insurance that encourages early intervention.
As yet it has not been tried here, but an increasing number of US employers and insurers are moving away from the carrot to the stick. They feel that being nice does not work, as employees still sit around with a mega burger in one hand and a cigarette in the other.
Wal-Mart - owners of ASDA - says that starting in 2012 it will charge tobacco users higher premiums but also offer free smoking cessation programmes. Tobacco users consume about 25 % more healthcare services than non-tobacco users, says Wal-Mart, which insures more than 1 million people, including family members.
Veridian Credit Union wants its employees to be healthier. It recently added a wellness programme and voluntary screenings. It also gave workers a choice: quit smoking, curb obesity, or you’ll be paying higher healthcare costs in 2013.The unhealthy could pay up to 50% more.
Employers often offer smoking cessation classes and weight loss programmes, but few employees are signing up or showing signs of improvement. So now more US employers are trying a different strategy. They are replacing the carrot with a stick and raising costs for workers who cannot seem to lower their cholesterol or tackle obesity. They are also coming down hard on smokers.
An Aon Hewitt survey found that almost half of US employers expect by 2016 to have programmess that penalize workers for not achieving specific health outcomes such as lowering their weight, up from 10 % in 2011.
UK employers could try similar approaches, in poor jobs market they will meet with little resistance.
There are legal and moral problems but what the US does today, the UK tends to do tomorrow.
And even on privately bought private medical insurance – it may come. Why should a fit healthy correct weighted non-smoker pay the same as an unfit, unhealthy, obese smoker?