While attending my nephews’ birthday party this weekend, I was told a horrific anecdote by one of my family members. Their employer recently bought a larger retail space not far from their original building. The employer relocated to the larger building and merged departments and personnel. In the process, they’ve changed health care plans, forcing all of the employees to go through completely new rounds of health screening.
As part of the new plan, there will be a “wellness program.” Such programs seems to be more common in modern health plans, and their idea is simple. They are intended to reward good behavior (exercise, varied diet) and, by symmetry, discourage opposing behavior. This particular wellness plan is anecdotally implemented as follows. Each employee’s health will be screened to determine indicating factors such as blood pressure, cholesterol, blood sugar, etc. Those employees with the worst health will automatically be entered into the most expensive plans, and the wellness plan will serve as a carrot to this stick. Improvements in diet and exercise will result in lowering of premiums.
Speaking theoretically for a second, it seems that such wellness plans have their place. The leading killers of Americans are diet and exercise-related diseases (heart disease being the top killer). As such, these preventable diseases much necessarily be the things on which insurance companies make their most payout. A company looking to reduce costs is necessarily going to attach such chronic things.
Implementation seems to be the key, and the anecdote above suggests a rather poor way of implementing a wellness program. Rather than sticking people who fail their wellness screening (which, based on BMI, I would wager most Americans would fail even if they DO get exercise and eat a varied diet) with the costliest plan, it would seem to make a little more sense to start some significant fraction of the employees on a medium-cost plan. One can then use improvements in wellness to reduce premiums, and save the more expensive plans for the most extreme cases of poor health.
That said, this opens a new can of worms: when can an insurance company decide your health affects their bottom line so much that they have the right to toss you or jack up the price so much that you can’t afford care anyway? This question would be easy if a national health care plan existed; in that case, getting tossed doesn’t matter because you would still have minimum coverage. But such a plan doesn’t exist and it’s not on the table in any current debate. Lacking a public health plan, it seems we need insurance reform to prevent companies from finding new ways, clothed in an act of social good, to toss people from their plans.
Really, we as a nation need to solve the problem underlying poor health, rather than address only the symptom (increasing insurance costs). That problem is cheap food. Cheap food happens largely to also very poor quality food, far from what I would even like to call “food.” Until fruits, vegetables, and humanely raised and slaughtered meat and fish can compete with “the dollar menu,” we can expect the obesity rates to continue to climb. Until exercise and good food are things instilled in our value system, we can expect obesity rates to continue to climb.
Insurance companies need to stop acting like jerks. Without a national health care plan, their behavior needs to be checked by policy, and that policy needs to be motivated by identifying our health care values. Fundamentally, we need to continue to educate people about food, exercise, and the consequences of making choices devoid of a food value system. The problem with health insurance may be nicely illustrated by my family anecdote, but let’s not mistake the symptom for the cause. Let’s also not forget to find national medicine that addresses both.
