No, I didn’t misspell bagel, and yes, its anagram can help end the largely preventable epidemic of Type-II diabetes that was recently reported to afflict twenty-three million Americans—a rapidly growing group that is consuming a huge amount of our health care dollars. BAGLE is my acronym for a health insurance pricing system that would set insurance premiums according to each individual’s Behavior, Age, Gender, Location, and Employment/Extracurricular characteristics—but not medical condition or genetic makeup. It’s the Behavior part that deals with the diabetes problem, because preventing and/or controlling it is most often a behavioral problem.
The causes of Type-II diabetes are unknown but strongly correlated with obesity. I hasten to add, however, that there are also many people who have developed the condition despite their healthy lifestyles.
A prominent endocrinologist once told me that uncontrolled diabetes actually pickles a person’s body in sugar because of its inability to burn it. People get sick and prematurely die from the resulting complications, such as heart failure, kidney disease, blindness, and nerve damage. Fortunately, extensive studies have shown that these dire effects can usually be avoided by various combination’s of daily blood testing, diet, weight loss, exercise, medication, and sometimes even weight-reduction surgery.
Most people with Type-II diabetes have it long before they know it. And most people who know it fail to do enough to prevent the complications. It can be damned inconvenient to do multiple daily blood tests and to control diet, exercise, and medication, especially when there are no obvious symptoms. Because proper control often requires 24/7 attention, there is very little that doctors can do beyond diagnosing it, prescribing medications, recommending behavior changes, and then periodically testing the patient’s progress with something called an HbA1c test. As with most chronic diseases, the real responsibility for prevention and control lies with the individual who has the condition.
To help end the spreading epidemic of diabetes, we need more powerful short-term incentives for people to detect and control their weight and blood sugar. BAGLE would provide just such incentives by allowing health insurers to charge higher premiums to people who are overweight or who have high, but controllable HbA1c levels. Those able to achieve and demonstrate healthy levels of body mass and blood sugar would receive premium reductions or rebates equal to the estimated medical savings from the avoided maladies.
As a result, people who successfully pursue healthy lifestyles—including those with well-controlled diabetes—will no longer be required to subsidize those who don’t. No one would be forced to do anything, but those who don’t would end up paying more for their insurance. At the same time, the BAGLE rating concept recognizes that there are some people for whom no amount of effort seems to get their blood sugar under control. In such cases, there would be either medical exemptions from paying the higher premium or premium subsidies to cover the differential.
BAGLE rating does not punish the sick for being sick, but fairly assesses the costs of those who fail to manage their personally controllable health risk factors. It may be more difficult for some people to achieve control, but everyone will have the opportunity to pay lower health insurance premiums.