Privacy is true price of healthy worker discounts

Arthur Caplan, Ph.D. • E-mail

The latest fad in American health care is to give discounts to workers who are healthy. Many corporate CEOs and their benefits department managers are showing enthusiasm for the idea that workers who don’t take care of themselves ought to pay more for health insurance.

Like a lot of temptations, this one is attractive. Why should you pay the same rate for insurance as that bloated, pasty oaf of a co-worker down the hall?

But cupcakes, beer and cheeseburgers are not the only temptations you should try to resist. Paying less for being healthy is an enticement you ought to oppose as well.

The plan just announced by the giant HMO UnitedHealthcare is a good example of why some bosses are licking their chops at the fad. Workers can lower their annual deductible (the amount you pay each year for health care or drugs before insurance kicks in) if they take company-administered tests every year to check blood pressure, cholesterol levels, and weight and to see if they smoke. For each health goal employees meet, $500 is knocked off their deductible.

This bright idea comes all dressed up in the attractive language of personal responsibility. Who could possibly be against that? If your boss wants to pay you to stop unhealthy behavior, how could that be bad? You win, the boss wins, the insurance company wins. So what’s the problem?

A dumb idea
The idea that your boss or insurance company wants you healthy just because they care is, upon serious reflection, dumb. What your boss cares about is that you get to work, work hard, stay late and don’t jack up the price of the health plan. And the insurers may just be looking for a way to shift exploding health care costs.

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Sure, it’s great that companies are starting to jump on board the movement for a fitter workforce. Access to fitness equipment, a less stressful workplace and an office that is designed to protect your health would help employees meet important health goals. But you may ask, “Wouldn’t that require turning the workplace into a health club?” My point exactly. So unless employers offer you time to get to the gym, forget it.

It’s also unlikely that your boss will tell you to stop working through lunch or to quit moving heavy objects to protect your back. And it is also pretty doubtful that you want your boss to hire people to poke and prod you and to find out what you’re doing when you’re not at work.

Think about it. Do you really want your bosses and the insurance company giving you physicals and snooping around in your health care records to find out the most intimate details of your mental, sexual and physical health? It’s a pretty high price in terms of privacy to pay for a discount.

No end to policing
The emerging movement toward corporate health fascism is no friend to the chubby and wheezy among us. But, if allowed, corporate health policing won’t stop there.

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How long will it be before slackers will be told that discounts are over, and instead, surcharges on them will begin? Who will be next? The guy who skis on the weekends? The woman who wears high heels? What about the family that decides to have a baby, knowing the child may have sickle-cell disease or cystic fibrosis? Will companies be willing to put up with that sort of personal “irresponsibility”?

At least one employer is already headed down the punishment path.  Clarian Health, an Indianapolis-based hospital system, recently announced that starting in 2009 it will fine employees $10 per paycheck if their body mass index, blood pressure or glucose levels are too high.

HMOs and insurance companies have proven completely unable to contain rising health care costs. This is mainly due to the fact that costs are fueled by an aging population using more services, an increased reliance on technologies and drugs whose prices are out of control, topped off by a massive dose of error, fraud and administrative waste.

Unless we address those problems, it is only a matter of time before the smiling hand of management takes away the discounts and starts raising deductibles and issuing fines on the grounds that no employee who is sick or has a sick spouse or kid is blameless.

If you ski, fly a private airplane, drive go-karts, ride a motorcycle without a helmet, engage in risky sexual behavior, forgo a flu shot, sunbathe, eat rare meat, kayak, scuba dive or own a gun, you are defying medical wisdom and choosing to engage in unhealthy behavior.

Admittedly, no HMO or corporate health plan is going after those behaviors — yet.

So lose weight. Stay active. Get enough rest. Wear your seatbelt. Don’t do drugs. Don’t drink too much. Stop smoking. Do these things not because your employer is ready to slap a higher deductible on you if you don’t. Do them because you and your doctor know these are the healthy things to do.

Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.

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