Workers, Reform Yourselves, Or Pay the Piper

For behavior, man must learn it, as take diseases, one or another.

Francis Bacon (1561-1626), The Advancement of Learning

November 29, 2011 – Well, it come down to this – Be Well, Stay Well, Or Else. One of these Or Elses could be Farewell.

Learn to be well, behave yourself, stop smoking, cut down on the drinking, keep your weight down, lower your cholesterol, or else pay more for health care coverage.

Or else means you may not be hired, you may have to pay a higher health care premiums, deductibles and copays. You may not even be able to keep your job, and you may become persona non grata to your employer and your co-workers.

At least that’s how I read the story of “What’s End Game for Wellness,” as told by John Commins in the November 28 issue of HealthLeaders Media.

Commins cites a NYT report this month this month saying a growing number of employers are telling workers who smoke, are overweight, or have high cholesterol to pay a larger share of their health care costs.

The Times article says policies imposing financial penalties on employees' poor health choices have doubled to include 19% of 248 major U.S. employers. Benefit consultants Towers Watson projects a doubling of that number again next year.

According to Commins,

“ We are seeing a surge in the wellness movement – the idea that employees should take greater responsibility for their health or pay the consequences.

"At face value it seems reasonable. Why should the rest of us pay for your lousy lifestyle choices? However, the wellness movement also has huge potential for abuse and discrimination. It also raises troubling questions about who gets thrown overboard, and where we draw the line on employer intrusions into our personal lives.”

Much of this understandable, of course. Since 2001, family premiums have increased 113%, compared with 34% for workers' wages and 27% for inflation. And smokers and the obese cost employers and their co-workers a lot of money. Unhealthy habits, even gluttonous, behavior is one reason premiums rose 9% rise in 2011 to $15,073 for a family of four.

But then comes the Big Brother question. How much can and should government, which covers 30% of Americans and employers who cover 55%, intrude into personal behavior of insured Americans? I have not included the 15% uninsured, said by some to be the unhealthiest, and sometimes the most misbehaving of them all.

A second question is: how can you change an individual whose behavior is shaped by the culture in which he or she was born. We are all creatures of our culture, and American culture promises we can behave as we please as long as we don’t harm others. The harming others problem becomes relative when misbehavior of one individual raises costs to the employer and fellow workers.

Farewell,Be Well, and Stay Well

Tweet: Some 20% of employers this year, and perhaps 40% next year, are making wellness a criteria for health premiums charges.