Tuesday, August 06, 2013

Can My Company’s Wellness Program Really Ask Me To Do That?

I saw this letter from an employee concerned about health insurance premiums that vary depending upon a person's adherence to specific health measurements:
I see you’ve written several articles about the new health insurance laws, etc. The company I work for has [a major national insurer]. Last year we received a $25 discount bi-weekly if we filled out a health questionnaire, which of course everyone felt compelled to do as that would be a savings of $650 per year. Most people I spoke to felt uneasy doing it, as they felt it would lead to other invasive practices. Well, sure enough, this year, if you DON’T smoke cigarettes you get $10 off bi-weekly, but to get the additional $25 not only do you have to fill out a questionnaire, but everyone employed [here] (and taking the health insurance) has to have a screening which involves:
1. Waistline measurement
2. Blood pressure measurement
3. Blood draw to test for glucose, HDL and triglyceride levels.
If you do not pass these tests, you will lose your $25 if these are not brought down to an acceptable level by August (when we will be tested again).
Needless to say, this really shook a lot of people up, as it is so invasive, and is this even legal?
Would love to hear your thoughts on this.
The reply, by "Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal" was:
"Let’s cut to the chase. Yes, it’s legal. ... Here’s the bottom line: Under federal law, your employer can vary your health insurance premium by up to 20% based on a “health factor;” that goes up to 30% as of 2014 and the government could eventually raise it as high as 50%."
This isn't about health, it's about profit. It's about drawing people into a system and having them pay for overpriced products and services. It's a very complex and convoluted system that shields this motive. Former insiders such as Wendell Potter have written extensively about it.


Steve Parker, M.D. said...

But it could also be about encouraging
people to take responsibility for their lifestyle choices.

We all agree that regular exercise prolongs life and prevents some cases of cancer, diabetes, high blood pressure, and heart disease. How about giving someone a discount on their insurance premium if they can do pretty well on a treadmill or bicycle exercise stress test. Re-test every year or two. Program could be entirely voluntary.


Bix said...

These programs are insidious and unethical profit generators for business. They aren't about helping people live healthier lives.

You can encourage people to take responsibility for their lifestyle choices in other ways. Not only do these games with health insurance make the health and medical industries richer at the expense of individuals, but they discriminate ... they discriminate based on age, socioeconomic status and race, even genetics (if you have a genetic disorder that makes it harder for you to meet certain "health standards".)

By the way, GINA is supposed to prevent disclosure of genetic conditions. I don't see how these programs get around that. The article even mentioned this: "Health Risk Assessments [like measurement of blood pressure and waist circumference] are sort of a legal land mine under the Americans with Disability Act and GINA [which protects genetic privacy]."

Bix said...

One big way you can improve the health of Americans is by making a college education more accessible and affordable. Better educated people have been shown to have better health. You can do that by reducing the costs to borrow money for education, student loans, and by developing grant programs. Unfortunately, we're going in the opposite direction.

Bix said...

When people can't meet the numbers, the "health standards," such as a cholesterol below 200 mg/dl, a blood pressure below 120/80 mmHg, a fasting blood glucose below 100 mg/dl, they'll be sent to their doc. Of course they'll be told to try eating better and exercising more first, but invariably they will go on meds ... statins, ace inhibitors, metformin. And they'll have to be monitored. And they'll have to pay copays, co-insurance, deductibles, and of course any cost for the meds and supplies like blood glucose meters and strips, which are already overpriced in the US. And it will be years of this kind of costly monitoring that thrills the medical establishment.

The numbers of people, the prevalence, of prediabetes and prehypertension and transient high blood cholesterol, let alone the actual diseases, are through the roof in this country. The insurance companies and BigPharm are practically salivating with the idea of bringing all these people into the fold.

Steve makes a good point about improving health in other ways. Sure, employers could build a safe walking path in the vicinity, offer paid paternal and eldercare leave, reimburse for education, build a cafeteria and stock it with not only healthful prepared food but healthful stocks that people can take away to prepare healthful meals at home. There are so many things an employer can do. The reason they are playing games with health insurance premiums is because the insurance companies are making deals with them. It's about profit ... for everyone involved.

Angela and Melinda said...

Whoever said our corporate oligarchy isn't all about "insidious and unethical" profit generation???!!! Insurers are among the worst offenders, as you know & have discussed in other posts.
And *please* take it from me: a college education these days does not guarantee good health or any of its components. Almost all my teenage students smoke, drink, do drugs, and are WAAAAAYYYY overweight! It's the way they were raised by their 40-something parents, the only way of life they know, whether they go to college or not! It's just pathetic, it really is.
Tennessee, where I worked, had a great, state-sponsored health insurance program that for a long time didn't offer these financial incentives. Then, as funding to the states has gradually been getting cut, they no longer can afford to. So they offer *optional* health-checkup-based incentives for lower premiums. So we saved about $1800 a year for the two of us. (Not to be sneezed at, in my opinion at least.) And if someone's numbers are above normal on various parameters, they do *not* have to go to their doc and be forced to take meds. They simply pay a higher premium. And why not? Why should the rest of us shoulder the financial burden that such people place on the already staggeringly expensive healthcare system. You don't have to post this, but it's just how I feel about the issues.

David said...

I see this as an experiment within the healthcare industry. If significant profits result from programs like this, they may become standard.

However, if firms want to attract the best talent, offering good insurance rates will help. For example, if I felt that my insurance rates not acceptable, I would talk with my employer. They could provide me a raise or cover more of my insurance costs. If they didn't do either, I would go and find a firm that appreciated me more.

Bix said...

@Angela and Melinda,

A college education *does* lead to good health. I take it from my studies. Here's one:


"... an enormous body of evidence documents that longevity increases with greater educational attainment."

Discounts in health insurance premiums are a smokescreen. The plans are priced high and then adjusted, like sale prices in department stores, e.g. the insurance companies want an extra $50 this year, so they say the plan is now $60, BUT we'll be a good guy and cut $10 for people who do x. People are still paying more. It's a game. Insurers aren't taking a cut.

These variations in health plan prices based on health status are just another form of "preexisting condition." It's discriminating and it's repugnant.

It's a terrible situation we have here in the US. We set it up for people to fail, and when they do, when they - by failure of society to make it possible for them to transcend their class - adopt the behaviors of their parents and friends, we blame them. We ridicule them. "I'm not paying for people who don't take care of themselves!" We already do pay, we pay by our taxes, by our own health premiums. Why not change the environment so good health is the default? Instead of disparaging individuals?

People don't care about public health in this country. They care about protecting their own privilege. Half of all children in the United States grow up receiving some kind of food assistance. They didn't do, or not do, anything to be born into that. Instead of lobbying for parental leave, for lower student loan rates, for affordable quality daycare, for SNAP, people instead just want to be entertained. They want to show off their things and put others down so they may feel elevated. It's almost an athletic event! Narcissism and consumption are out of control.

You are in a unique position to mentor your students, to teach them - literally and by example - about a healthful lifestyle. To love and care for them and guide them to a full and meaningful life.

Bix said...

By the way, I wasn't just pulling a number out of a hat when I said half of all children receive food assistance:


" Administered by USDA's Food and Nutrition Service (FNS), almost half of all infants and about a quarter of all children ages 1-4 in the United States participate in the program. WIC is USDA's third-largest food and nutrition assistance program."

That doesn't include children on food stamps.

Angela and Melinda said...

Bix, there may be a statistical connection b/tw increased longevity,compression of mortality, and a college degree, but you couldn't prove it by the college where I teach now (have taught--I'm not going back).

I do see that the study's authors are hypothesizing about a group of non-institutionalized adults 50 and older. That makes them equivalent to the students I taught in Memphis, who were wonderful and enthusiastic and hard-working, and trying to take advantage of their education (as most of them were in their 20s & 30s, working a full-time job, caring for a family, AND paying their own way to go to school).

But if you came down & taught where I teach now (not Memphis), I think you'd see the staggering resistance to learning and/or change of habitual behaviors among today's teenagers at an academically mediocre (albeit expensive) college.

I *was* in a unique mentoring situation in Memphis and loved the students (who mostly are in their 40s & 50s now). Today's average teenage college student, though, is a whole different ball of wax, generally (of course there are exceptions). And I don't think that this younger generation will reap the same benefits of a college education as the older students (now in their 50s) did. Though of course it would be wonderful if it did help them the way you describe. They need the help!

As I say, this is just my opinion, based on teaching these younger kids since 2004. I'm not necessarily correct, nor can I cite statistics.
~Melinda, not Angela