What's the End Game for the Wellness Movement?

John Commins, for HealthLeaders Media , November 28, 2011

For example, The New York Times reported this month that – rather than rewarding good behavior – a growing number of employers are telling workers who smoke, are overweight, or have high cholesterol to pay a larger share of their healthcare costs. According to The Times, policies that impose 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.

The case against smoking is obvious. It's a vile, dangerous, and expensive habit that claims thousands of lives and costs billions of dollars each year for otherwise preventable healthcare. If you light up, you should pay more.

It gets a little stickier, however, with issues like high cholesterol, and overweight. How will companies determine how much more an overweight employee will pay? Will they literally exact a pound of flesh? Will we have a ritualized public weigh-in on Premium Supplication Day?

There are also economic issues at play here. Studies have shown that people who earn less money tend to be more inclined toward overweight, use tobacco, and engage in other unhealthy lifestyle choices. Are we prepared to impose another tax on the people who can least afford it?

Cigarettes cost more than $50 a carton, so smokers can afford to pay more. Again, it gets a little trickier with obesity and high cholesterol. Maybe that well-intentioned smoke-free-but-overweight worker lives in a rougher neighborhood that doesn't provide safe and convenient venues for exercise.

Maybe the closest Whole Foods Market is across town, and the only store nearby is a Kwikki Mart that is known more for its microwave burritos than for fresh produce. Maybe that worker has two jobs and doesn't have the energy at the end of a 16-hour day for a jog around the block on dimly lit streets. Are we are going to punish this person?

There is also the slippery slope argument about wellness that affects everybody because we all have bad habits. Smoking and obesity are low-hanging fruit.  The wellness crusaders will return. Will social drinkers be told to stick a cork in it or pay more? What about rock climbers, sky divers, bicyclists, skiers, or others who take part in nominally hazardous hobbies? Will they be told to limit their exercise to a treadmill?  And, how and who will we test for compliance?

It probably won't play out like this, but this is not a far-fetched scenario. The wellness movement might slow healthcare cost growth, but it won't stop it.  

Along with the annual hikes for premiums, co-pays and deductibles, National Premium Supplication Day may soon provide workers with a list of personal fitness mandates. Much of this seems like rearranging deck chairs on a sinking ship.

As healthcare costs continue to rise, like frightened passengers, we'll become more desperate about containing those costs, and more willing to toss to the sharks those lesser among us who don't pass muster.

John Commins is a senior editor with HealthLeaders Media.

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