Fat Discrimination

By B. Deutsch

This article is from the January/February 2010 issue of Dollars & Sense: Real World Economics, available at

issue 286 cover

This article is from the January/February 2010 issue of Dollars & Sense magazine.

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This cartoon is from the January/February issue of Dollars & Sense: Real World Economics available at

Ampersand cartoon on Keynes

Get on That Scale!

By Katherine Faherty

Starting this year, North Carolina teachers and state employees will be subjected to health compliance testing to qualify for their health insurance. The variables: smoking and weight. To enroll in the standard insurance plan, employees will have to attest that they—and any spouses or dependents—are nonsmokers with a Body Mass Index below 40. Otherwise, they can only enroll in a “basic” plan with higher deductibles, higher co-pays, and generally skimpier coverage. Exceptions are only granted for physician-verified participation in formal weight-loss or smoking-cessation programs. And to prevent “cheating,” anyone enrolled in the standard plan must agree to random tobacco-use and weight checks.

You can debate whether smoking is more addiction or more choice, or whether obesity results from bad genes or bad eating habits, or the extent to which obesity is a health risk. But in the end, when it comes to health care, it’s all about money. The state’s new insurance rules, also known as the “Comprehensive Wellness Initiative,” provides less coverage to people who are more likely to need medical care. Now there’s a sensible way to cut health care costs.

Barry Deutsch is a cartoonist living in Portland, Ore. An original "Ampersand" cartoon appears in every issue of D&S. See more of his work at

Katherine Flaherty is a Dollars & Sense intern; she graduated from Hobart and William Smith Colleges in 2009 with a degree in economics.

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