Coercing Personal Behavior
Monday, 11 May 2009
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.
Put those programs together with total body airport X-ray machines and what do we have left?
Nowhere to run, nowhere to hide. Is that what we want for the world? Is there any privacy?
I used to contemplate this while teaching in a big city high school. Staff washrooms were like echo chambers. You could tell who was in each stall by the shoes under the door. Anything we said was carried through the cement block walls.
We have google earth, so people can track whoever/whenever...
"Hey, is that one eyed cat walking into that bar? No, you moron. That cat is walking OUT of the bar."
Posted by: doctafill | Monday, 11 May 2009 at 03:59 AM
Who is Max Baucus, Montana Democrat? Why now? This bill seems to go hand-in-hand with his disdain for single-payer health supporters and their demand to have a voice at current Senate meetings on the healthcare mess.
Baucus appears to be the leading shill for the insurance industry. We still can deluge congress with what the majority of Americans want--Medicare for everyone. Links to orgs hoping for your signature at my post, "Katie & Three Doctors Arrested in Senate Hearing."
Posted by: naomi dagen bloom | Monday, 11 May 2009 at 04:35 AM
If lawmakers are thinking about penalizing citizens for perfectly legal activities such as smoking, drinking, eating and not exercising, then they should also penalize corporations that promote and profit from such activities. And while they're at it, make 'em illegal (if they dare!). Penalizing a citizen for a personal and legal activity is the easy/sleazy way out, citizens have far less recourse than corporations against such restrictive measures.
It really disgusts me that lawmakers refuse to penalize those that profit from unhealthy behaviours, and instead take it out on those sucked into such behaviours. Blaming the victim.
Posted by: anne | Monday, 11 May 2009 at 05:10 AM
I absolutely hate the health Nazi mentality that is going around. I live with my mother who smokes. Should I be denied a job, a promotion, or be penalized because I can't pass the blood test for nicotine (thanks to passive smoke) when I don't smoke and never have? I absolutely hate the make-work style of exercise that would require me to take an hour a day and spend it non-productively on a damned treadmill. Why should I give up an hour of needlework to go nowhere on the treadmill? My blood pressure is in the lower range of normal. My cholesterol is well in the normal range. But like your friend, I have not been below 180 lbs for forty years. Which damned measure are they going to use to 'assess' me? Why the hell should THEY be allowed to assess me anyway. The whole situation ticks me off. (I am trying to remain polite but this....)
Posted by: mary walker | Monday, 11 May 2009 at 06:08 AM
This is tricky...we have accepted seat belts in our cars and helmets on (most) motorcycle riders. So where is the point where we consider government to be intrusive? Do I get to decide, or do 'they'?
Posted by: Steven | Monday, 11 May 2009 at 06:46 AM
Steven...
I think we need to make a distinction between government-mandated behavior and corporate monitoring - the latter of which I'm writing about today.
With government, we have recourse even it is small through our representatives and sometimes a vote. Such requirements as bicycle helmets and seat belts often began at the local, grassroots level, parents concerned about their kids, etc. and moved up from there.
Corporations mandate from the top and penalize employees for not following their rules, and as I noted in the story, some have already overreached by mandating spousal behavior.
We already leave our civil rights behind when we enter our places of employment. Corporate mucking about in health care can only lead to erosion of personal preference and would undoubtedly reduce choice for employees. They've already reduced their health coverage to bare bones and, in many cases, eliminated it. Now they want to enforce corporate health behavior rules?
That should never be the province of employers whose only responsibility is to their shareholders not their employees.
Posted by: Ronni Bennett | Monday, 11 May 2009 at 07:04 AM
That's a nice and precise distinction, Ronni. Corporations are a much greater threat to our personal freedom than the gov't is. It's a world that was unimaginable to the founding fathers.
It seems to me that for the last 20-some years, the gov't has been cast in the role of the enemy while big business got a free ride.
There was a little satirical newspaper here in Buffalo years ago; it was shut down when a local businessman threatened them with a lawsuit for writing negatively about him. They couldn't afford to fight him, so they quit publishing.
Posted by: mary jamison | Monday, 11 May 2009 at 07:13 AM
This is a an interesting issue. So many of us gain weight as we age. Many, like me, have fought weight gain with various degrees of success for a lifetime. I don't like the thought of being penalized for a genetic predisposition to overweight.
I do not think that governement reps. are any better qualified to meddle in personal health issues than corporations. Either way it is a bureaucrat who is enforcing overarching standards which are designed basically to save profits or tax dollars with a veneer of "interest" in our health.
For those of us who are choosing to smoke or overeat or to have unprotected sex, I think charging an extra surcharge might be justifiable, as long as it is not punitive. But as I understand it, insurance is supposed to distribute risk.
Maybe that is the problem. Too many of us fall into the high risk category. Or maybe the high risk category need refinement.
Posted by: Sophronia | Monday, 11 May 2009 at 07:36 AM
As I see it, corporations get involved only insofar as health benefits are linked to those employers. I'm guessing employees are "monitored" along with their spouses in the sense that they must verify a claim for reduced costs based, for example, on smoke-free homes, which we know save health and lives.
I think the link between employment and health care access should be broken. But at that point, I will still favor rewards for healthy lifestyles. The truth is that I've been contributing to healthcare costs for a lot of people who don't make my healthy choices. Is that fair?
Posted by: Sixty and Single in Seattle | Monday, 11 May 2009 at 07:40 AM
Corporate control versus government control - aren't they almost synonymous? I am not sure you can separate the two in terms of discussing the loss of personal freedom/privacy.
Nowhere to run, nowhere to hide. Is that what we want for the world? Is there any privacy?
You nailed it, Doctafil.
My husband and I had the same sort of conversation all last week, and we are confounded by the responses of our adult children (who don't seem to care about the issue, in fact, consider it a "non" issue) and coworkers who shrug and say, "I'm not doing anything wrong, so no worries."
Yeah, well, you're not doing anything wrong today, but tomorrow may be another tale.
The nonchalance and apathy over the loss of personal freedom is chilling and beyond comprehension to me.
Wake Up, America! Or be prepared to become the Borg.
Posted by: Cowtown Pattie | Monday, 11 May 2009 at 07:40 AM
Coerced lifestyle modifications and employment bias against those that don't meet their standards of "health" smacks of the same discrimination as ageism, sexism and other isms so rampant in our society.
It reeks of the invasion of privacy, the right to live your life as you see fit (no pun intended).
It's one thing to encourage what the health gurus call a "healthy lifestyle," and quite another to force it upon you.
There are millions of Americans who will never meet the BMI and other standards set by the health fanatics. Witness Ronni's friend. Witness me: I gained 50 pounds due to the mental health medications I have to take to remain stable. What do I do? Stop taking the medications and rave while skinny, or live a productive, functional life 50 pounds overweight?
I'm wondering whether this current invasion of the right to be left to live your life as you see fit would stand up under a constitutional challenge in the Supreme Court? I'd bet it wouldn't.
Posted by: Mike Nichols | Monday, 11 May 2009 at 08:00 AM
This is another way to legalize discrimination.
Posted by: Stacie | Monday, 11 May 2009 at 08:06 AM
Coercion has ever been a facet of human society (there is no need for coercion when one lives, alone, not surrounded by others.) Ronni wishes to coerce her condo folks to live life in a manner that pleases her. I have no problem with that.
In small communities, we coerce (or, at least, used to coerce) other people's kids into behaving "acceptably" by the implied threat of passing along to their parents, news of their transgressions. I have/had no problem with that.
Unfortunately, population has swelled to the point where large numbers of people are impacted by the actions of others. Undeniably, healthcare and workplace costs have risen due to the pandemic of obesity. I may not like having Big Brother look over my shoulder, but I certainly understand it. Perhaps it will even pursuade me to change my eating habits!
Posted by: Cop Car | Monday, 11 May 2009 at 08:21 AM
I an completely against any kind of legislation/corporate nannyism of this sort and I wrote this on my blog in 2006:
"Something I decided long ago is that you can't save people from themselves and that legislating morality is a lost cause and I suggest that our representatives in government do the same. I already have a mother who's been guilting me for decades about my bad habits and sins. Someone wiser than I said, "No man’s life, liberty, or property are safe while the Legislature is in session.” This has been attributed to everyone from Thomas Jefferson to Mark Twain and holds truer than ever today. The Constitution was not designed to legislate morality. Yes, the wise men who constructed it allowed for changes but I'm guessing they're rolling in their graves at what we have wrought. What's next? Banning obesity? I'm guessing that it causes more deaths than smoking and drinking ever did. And given the abundance of overweight children I see every day, it's going to get worse before it gets better. Didn't we learn anything from Prohibition? It didn't work and led and fed the rise of organized crime in this country."
I used to laugh when a wacky friend of mine would say, "I know my Constitutional rights . . . I can call my mother any time I want." The way things are going, that might be the only right we have left . . . although you might be wiretapped.
Posted by: Kay Dennison | Monday, 11 May 2009 at 09:30 AM
This is just one more reason to push for the single payer health plan.
I don't have a problem with giving information on how to live a healthy life style, but to mandate it is outrageous.
Posted by: Darlene | Monday, 11 May 2009 at 09:57 AM
This one is a classic American effort to pretend you can solve social problems through individual action. Baloney!
Why are we a super-sized, addicted nation? Because that habit-forming lifestyle has been profitable for many large corporate entities.
If the government starts pushing those same entities by making an unhealthy populace less profitable, guess what? The sellers of lifestyle will change the preferred style and drum into us that we must engage in rat race health practices (if the government makes it profitable.)
And through it all, corporations and government will pretend its our individual choices that produce social outcomes. Bull! We'd walk if we hadn't made our surroundings unwalkable. We'd eat local if we hadn't been taught to think cardboard "tomatoes" should be available in February.
Health follows on availability of low stress, livable communities. This nation goes instead for riches for some and inculcating anxiety-ridden mass consumption of things of dubious value for most. (The truly poor don't count at all, as they don't feed wealth.) That outcome is not a result of individual choices. It's a systemic outcome of being willing to allow severe inequality in how we live our lives.
Posted by: janinsanfran | Monday, 11 May 2009 at 10:06 AM
You might be in the minority nationally but I agree with your concerns. There can be people who smoke, drink to excess, are fat, etc etc and still have very few health problems. To allow the government to regulate these things through corporations or anything else seems wrong. It might be fair to give lower insurance premiums to people who exercise good health habits but i have a friend who is the right weight, does all the right things and yet for genetic reasons has a lot of doctor visits. I don't do all these things, rarely see a doctor; so how does the economic system figure this? It's a slippery slope for sure as it can relate to a lot of things that we don't want government getting into.
Posted by: Rain | Monday, 11 May 2009 at 10:18 AM
How far will or could the "company and the health czar" take this oversight?
Perhaps they will require a camera
that can be monitored by headquarters to ascertain which employees are driving while texting or talking on cell, speeding, and other conditions which have been proven causes of accidents and injuries which insurers generally have to pay for.
Or the stresses caused by a spouse who is cheating and the detrimental health consequences on the insured children of the ensuing divorce.
And what about those who never ever floss when gum disease has been proven as a predictor of heart disease.
And who is going to monitor the insured to make sure he takes his blood pressure meds at the same time each day.
And how many drinks of alcohol per day? Is there someway for the company to measure the empty bottles in the trash.
Required daily report of food consumed and regularity and consisity of ensuing BM's?
And what about the unbearable stress of big brother monitoring every thought and action causing blood pressure to go through the roof because of all this malarkey?
Posted by: chancy | Monday, 11 May 2009 at 12:42 PM
Almost 40 years ago,the behavioral scientist, B.F. Skinner published "Beyond Freedom and Dignity" where he proposed the idea that in the current age (circa 1970) , population growth and technological progress made our so-called god-given rights as described in "The Bill of Rights" luxuries we could no longer afford.
Needless to say, Skinner's work was greeted extremely mixed reaction.
The book argues that entrenched belief in free will and the moral autonomy of the individual (which Skinner referred to as "dignity") hinders the prospect of using scientific methods to modify behavior for the purpose of building a happier and better organized society.
Beyond Freedom and Dignity may be summarized as an attempt to promote Skinner's philosophy of science, the technology of human behavior, his conception of determinism, and what Skinner calls 'cultural engineering'.
Now forty years after the publication of Skinner's controversial work, we should ask ourselves:
Can we afford to allow almost half of our population to eat themselves into chronic obesity and other related conditions?
Can we afford to let a sizable proportion of our young adults become addicted to "recreational drugs" or kill themselves and others on the highway in vehicles that may be "unsafe at any speed" and certainly when driven at 80 mph or faster?
Can we afford to allow chidren of 15 or 16 to give birth to babies they are not capable of caring for or educating?
Posted by: mythster | Monday, 11 May 2009 at 01:23 PM
This seems to be another unfortunate example of the burgeoning influence of modern day Corporatocracy.
I am highly skeptical of any business entity's ability to look after anything more than their bottom line.
I think the quote from the movie "A bridge too far" when the Germans asked for a surrender from American forces would be the correct answer to Corporate rule here.
As I recall it was "Nuts"
Posted by: Rich | Monday, 11 May 2009 at 02:16 PM
"I think we need to make a distinction between government-mandated behavior and corporate monitoring - the latter of which I'm writing about today."
As a Libertarian, mandated personal behavior by ANY entity is loathsome to me.
I don't trust the government in this regard any more (and probably less) than a corporate entity. They are in bed together more than we peons have any idea. Defense contractors? You bet. Big Pharm? You better bet! Universal Healthcare will only deepen this connection and control over us. I truly do not know how you can separate the two powers. Perhaps in times past they were separate. I don't think that is the case any longer.
I am not a cynical person by nature. It did not feel good at all to write the previous paragraph. In fact it makes me want to cry because despite it all, I love this country.
Posted by: candace | Tuesday, 12 May 2009 at 05:17 AM
PS. I know this is not directly Elder related but hey, even Elders have to eat!
I'd love your take on HR 875 and S 425, Food supply bills otherwise known as "Monsanto's Dream Bills". Another big way corporations and government come together.
Talk about frightening. My very liberal organic farmer neighbors are shaking in their garden clogs.
So should we all.
Posted by: candace | Tuesday, 12 May 2009 at 05:35 AM
Thanks for the post, Ronni, and all the very interesting comments. Janinsanfran said it best for me.
Posted by: Kate | Tuesday, 12 May 2009 at 07:46 AM
Whatever happened to freedom of choice?
Posted by: SuzyR | Tuesday, 12 May 2009 at 10:40 AM
Corporations always have a clear choice here ... just stop offering company-paid health care plans to the employees, and offer them a plan they can participate in at the amount that the insurance companies charges them per enrollee.
If I am not mistaken, I believe that insurance companies charge premiums on the company group plan on a statistical basis of what the overall plan costs each year in health care costs, not what one individual costs.
If that is the case, then each one of the company's covered employees is sharing the burden equally everyone -- including the overweight/obese employees who suffer much more from diabetes, heart problems and other health problems than the more robust, healthier employee, and cost the plan a great deal more each year.
This leads me to believe that if the employees understood this, many would be repelled by the knowledge that they were each paying higher health care costs due to other people’s lack of caution and care for their health.
I know I would object to paying for other people's idiocy.
Posted by: Miki Davis | Tuesday, 12 May 2009 at 11:25 AM
It's a sticky issue and I've happily worked in the business world my whole career... BUT... do we really want corporations controlling this? Not me.
Posted by: Nikki | Tuesday, 12 May 2009 at 10:37 PM
I am unequivocally opposed to government, corporations or any group dictating anyone's health care. I believe health care for all can be provided without resorting to this sort of management. I view even the possibility of this loss of freedom as very dangerous. I think we should all be expressing our opposition loudly and vocally not only on the Internet but to media and Washington officials -- you know, those people who claim they represent us. I don't Twitter, but maybe those who do could Twitter our President. Am thinking I should Facebook and spread the word there, too.
Posted by: joared | Friday, 15 May 2009 at 09:44 PM