Monday, October 19, 2009

Wellness Initiatives – the Opposite of Hunger

The Obama administration has stated that one of the most significant goals of the proposed healthcare legislation is to prevent insurance carriers from terminating or denying coverage or charging higher premiums by reason of preexisting conditions. But there is this little loophole, naturally favored organizations like the U.S. Chamber of Commerce and the National Association of Manufacturers, which allows employers to impose penalties on workers who are, frankly, out of shape. The October 16th Washington Post: “By more than doubling the maximum penalties that companies can apply to employees who flunk medical evaluations, the legislation could put workers under intense financial pressure to lose weight, stop smoking or even lower their cholesterol.” The same types of parameters would also apply to individual policies.

Let’s face it… America is fat. Fat… particularly with a touch of demon tobacco… causes myriad health issues, prominently including heart disease, stroke, cancer and diabetes. In the insurance world, people who are in shape subsidize people who are not. The older you get, in shape or not… until you hit Medicare… the higher your premiums go. Hey, your “parts” are wearing out! No one is talking about taking the age variable out of the calculation for healthcare premium (damn!). But tying costs to healthy lifestyle choices sounds fair, actually, and those some folks actually have medically caused obesity and cholesterol issues, which diet and exercise alone cannot counter (why does this sound like a TV ad for a diet drug?), would have a carve-out for these truly medical conditions.

Unions, the American Heart Association, the American Cancer Society and the American Diabetes foundation all oppose this “wellness” provision. But the policy is clearly moving in that direction. “The bipartisan initiative, largely eclipsed in the health-care debate, builds on a trend that is in play among some corporations and that more workers will see in the benefits packages they bring home during this fall's open enrollment. Some employers offer lower premiums to workers who complete personal health assessments; others limit coverage for smokers… In effect, [these features] would permit insurers and employers to make coverage less affordable for people exhibiting risk factors for problems such as diabetes, heart disease and stroke.” The Post.

In fact, these penalties could force folks entirely out of the universal coverage that everyone in favor of healthcare reform seems to support. And aren’t obesity, smoking, etc. “preexisting conditions”? But the fact remains, if we really want to reduce the burdensome cost of healthcare, Americans should be rewarded for healthy habits and be held responsible, where free choice of lifestyle is concerned, for what they choose to do to their bodies. And costs will skyrocket without some attention to the underlying causes. Want a very recent example? The October 19th NY Times: “The basic Medicare premium will shoot up next year by 15 percent, to $110.50 a month, federal officials said [Oct. 19th].” Houston, and every city in the United States, we have a problem. “Supporters say economic incentives can prompt workers to make healthier choices, thereby reducing medical expenses. The aim is to ‘focus on wellness and prevention rather than just disease and treatment,’ said John J. Castellani, president of the Business Roundtable.” The Post. We’ve got to drill down on costs or we aren’t going to be able to afford any healthcare plan.

How much are these possible “wellness” premium increases that are we talking about here? “Under current regulation, incentives based on health factors can be no larger than 20 percent of the premium paid by employer and employee combined. The legislation passed by the health and finance committees would increase the limit to 30 percent, and it would give government officials the power to raise it to 50 percent.” The Post. That’s a lot of money! Some companies are raising the deductibles (sometimes by thousands of dollars) in their plans for smokers and those who are overweight. Expect individual plans to mirror these features. Incentives for participation in anti-smoking clinics and weight-loss programs are also choices that some employers make.

There is a complex balancing act going on in the crafting of healthcare reform. As I’ve blogged before, were paying way too much time on how we charge and pay for this plan and way too little on managing excessive “defensive medicine,” overtreatment and skyrocketing pharmaceutical costs. What’s your opinion? Is this “wellness” vector a good thing or a bad thing for our new healthcare policy? Given the number of overweight Americans, it is pretty clear that a lot of people are going to be paying a lot more if the “wellness” incentive plan passes. Is the “public option” alternative (very basic, no frills insurance, provided directly by the government) a reasonable addition to a program of creating cost competition (and hence savings)? What are your thoughts?

I’m Peter Dekom, and I approve this message.

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