The Army solved this decades ago with tape tests. Been a quarter century since I had to take one, but it used to be the ratio of various bodily circumferences. If your stomach to chest ratio or your neck to bicep ratio were reasonable, you were OK regardless of physical weight. It takes perhaps a minute per soldier, as compared to recording weight which takes only seconds, so the simple BMI is still useful as a time saving prescreen. It worked very well decades ago, so an optimist would think the Army still tapes and a pessimist would assume it no longer tapes.
I would imagine if 320 million people are going to be measured for financial punishment purposes, there would be a startup opportunity in some kind of 3-d scanning appliance that could auto-generate circumference measurements.
Of course where money is involved corruption will develop and inevitably there will be clinics where patients are asked politely to measure themselves and record their own numbers, such that the promised savings will never occur.
Yes some people will always try to commit insurance fraud. That's nothing new. Insurers typically guard against that by looking for suspicious data patterns. And most providers won't participate in fraud due to the risk of getting kicked out of insurance networks, or being punished by state licensing authorities.
We already have a 2D scanning appliance which can measure body fat to 1% accuracy, even for weightlifters. It's called a DEXA scan. Currently scans cost about $50 and take several minutes, so not really practical for screening millions of people every year. But I'm sure engineers are working on improving cost and speed.
It's really not. BMI is wildly outdated, and especially doesn't deal well with anybody who has a larger body frame. At the thinnest I've ever been in my life, when you could see every rib hanging out, I was still forty pounds heavier than what BMI charts calculated my weight ought to be.
I don't know for a fact, but I would very much expect the answer to be yes. The relevant metrics to look at would be body fat percentage, cholesterol, triglyceride, and blood sugar levels, resting heart rate and blood pressure, and insulin sensitivity. After correcting for those, weight is just not a risk factor, so far as I know.
I would imagine if 320 million people are going to be measured for financial punishment purposes, there would be a startup opportunity in some kind of 3-d scanning appliance that could auto-generate circumference measurements.
Of course where money is involved corruption will develop and inevitably there will be clinics where patients are asked politely to measure themselves and record their own numbers, such that the promised savings will never occur.