Momentum is growing throughout corporate America, the health care industry and Congress to control workers' health behavior. There are proposals in Congress that would make it easier for employers to offer financial rewards or penalties to employees for certain health behaviors, and would provide various federal subsidies to employers who offer wellness programs.
One proposal from two Democrats, Max Baucus of Montana and Tom Harkin of Iowa, would focus on tobacco use, obesity, physical fitness, nutrition and depression:
Under Mr. Harkin's proposal, employers could obtain tax credits for programs that offer periodic screening for heath problems and counseling to help employees adopt healthier lifestyles.”
- - The New York Times, 10 May 2009
Already, many corporations, mostly large ones, offer wellness programs that include prevention information, health risk assessments, monitoring of chronic diseases and conditions, nutrition seminars and health coaches. Some have in-house fitness centers.
Among incentives for reaching health goals (such as lower weight, cholesterol and body mass index) are retail gift cards, paid gym memberships and insurance-premium discounts. Among the penalties are insurance-premium surcharges and the State of Alabama has announced that in 2010, it will begin charging its employees an additional monthly premium for health coverage if they do not participate in the state's wellness program. One company in Michigan not only mandates nicotine testing of employees, but requires employee spouses to be non-smokers too. (See Harvard School of Public Health.)
A third of American adults are obese, and heart disease - related, in many cases, to obesity, tobacco use and high blood pressure - is the number one killer in the U.S. Clearly, healthier behavior can go a long way toward reducing disease and death and health care costs too.
Nevertheless, I am distrustful of turning over the monitoring of workers' health to corporations. There is too much potential for unintended consequences, abuse and coercion particularly when a company, like that Michigan employer, demands certain behavior of non-employee spouses, which is appalling. I am not responsible for my husband's (if I had one) behavior.
Although statistics can give an overall picture of cause and effect, they cannot deal with individuals and applying standard goals for weight, blood pressure and other indicators of health is certain to penalize some people.
I have a friend of 30 years who, by actuarial standards, is obese. For as long as I have known her, she has spent at least an hour a day on a treadmill, lifts weights, has been a vegetarian all that time and maintains normal blood pressure and cholesterol levels. But her weight, at its lowest has never been below 180 pounds. She's just built that way.
Should she be required to pay a surcharge on her health coverage because her employer thinks she should weigh 130? I don't think so.
How long will it be, given federal tax breaks, before corporations begin discriminating against employees who can't meet their standards? Or refuse to hire them at all? Will people be demoted or be denied an otherwise deserved raise if they don't get to the gym as frequently as the company requires? Will the company health czar require people to take cholesterol and blood pressure drugs? Will people who have ice cream with lunch be turned in by their co-workers?
After a couple of hours searching the web, it became apparent that I am in the minority on this issue. Recognized health care organizations, in addition to Congress, the president and concerned individuals, are all gung-ho for corporate regulation of employees' health behavior – as, of course, corporations themselves are.
In that New York Times story yesterday, there is only this tepid critical statement:
”Critics say that holding people financially responsible for their health behavior is potentially unfair and that employers have no business prying into their employees' private lives.
“Lewis Maltby, president of the National Workrights Institute, a research and advocacy group, said financial rewards and penalties were often a form of lifestyle discrimination. 'You are supposed to be paid on the basis of how you do your job, not how often you go to the gym or how many cheeseburgers you eat,' Mr. Maltby said.”
Additionally, the dollar cost of corporate health monitoring will be high. You and I are sure to see it in increased prices of our refrigerators, television sets, cars and food.
All this would be moot if, as in all other industrialized nations, we had a national health care program. The better and more reliable place for health care information is with our physicians, not our employers.
At The Elder Storytelling Place today, in honor of yesterday's holiday, Johna Ferguson writes of Mother's Day.