There’s an adage that, except for their tax revenue, American business is something the left loves to hate. And who can blame them, what with executive compensation, minimum wage and overseas job outsourcing powering the left wing’s ascent faster than corporate gunships in a greedy search of Avatar movie unobtainium? Being the principal source of health insurance for their employees hasn’t helped the liberals’ view of American business either, not only because it gets in the way of their cherished public option, but because their constituents’ benefits have been squeezed by the specter of an unholy alliance with managed care over caps, deductibles, co-insurance and co-pays.
So when it came out that the Senate’s proposed health reform legislation would increase employers’ and insurers’ ability to incentivize employees’ participation in worksite-based health promotion activities, progressives zeroed on it like Air Force One on a Massachusetts political rescue mission. Believing that any use of any financial rewards is just plain wrong, opponents have cast incentives as penalties on those who don’t participate in workplace wellness programs – a sneaky, indirect and backdoor way of making the sicker pay more for their health insurance.
Egads. Follow this line of logic far enough and you’ll ultimately conclude employers have no involvement in health care. But wait a minute…maybe that’s the intent of my liberal colleagues. But I don’t think their reasoning holds up under the light of real world experience or what’s been published in the peer-reviewed scientific literature.
First off, federal law already allows employers and insurers to provide incentives up to 20 percent of the premium. Current legislation proposes to increase that to 30 percent. The point here is that argument over the use of premium differentials was settled years ago; what is different is the amount, which in the Senate bill, is intended to give employers greater flexibility in the design of their incentives.
Second, worksite wellness programs are almost always designed with the employees’ input. Early attempts to concoct programs ”from the top down” quickly established that they always fail, and fail miserably, no matter how much money is on the table. Premium incentives alone can be a necessary ingredient. But by themselves, they are not sufficient. Employers always have and always will seek their employees’ counsel over the many components of a successful program, including incentive levels.
Third, monetary incentives, like all employee incentives, are not the purpose but are really part of the solution to achieving outcomes in the fight against tobacco abuse, obesity, poor nutrition, lack of exercise and stress in the workplace. Communications campaigns, health risk assessments, building facility redesign, cafeteria menu selection, other aspects of the insurance benefit package, visible leadership support/participation and providing employee-free time are only some of the other ingredients that need to be assembled for this to work. The idea that this is only about the employees’ money is a myth. It’s about tackling issues that are driving up local health care costs and crippling our economy.
Fourth: There is considerable research that has shown that line employees welcome financial incentives. Unsaddled by an oppositional union leadership disorder to all things having to do with business, the rank and file support in favor of this is probably based on a perspective lost on their union leadership: money talks, especially when it’s walking into your pockets.
Fifth: Are there any reports, outside of some anecdotes framed by an extremist bias, of measurable harm to patients subjected to a premium differential? Other than conjecture or theory, there are none. What is true is that SOP in business is to study the outcomes of worksite wellness initiatives and PLEXEVAD (plan, execute, evaluate and adjust) the components of the program against the outcomes achieved. There is no scientific literature that has shown that patients’ access to care is hurt by these employer programs.
Sixth: Worksite wellness programs are designed by the same minds and energy that has propelled the United States to unparalleled economic achievements. While this record has not been free of any serious mishaps, the fact is that the genius of private enterprise is far more likely to develop successful health promotion initiatives than anything in the public sector. Case in point: who has been better at getting H1N1 vaccinations to persons at risk: Goldman Sachs or the New York City Health Department?
Last, I’m not hearing any suggestions about alternative approaches to health promotion from my colleagues, other than “no.” It is obvious that to succeed in battling the scourge of chronic illness, we’re going to need the unions and health care advocacy groups, as well as constructive participation of government, public health, academia, the health care system and the insurer community. The reason why benefits are being squeezed is because health care costs are exploding thanks to the very health care problems that worksite wellness programs address. Hobbling the employers is consistent with ultra-liberal disdain, but fails to capitalize on the fact that we’re all in this together. Business bashing is fine, but it’s time to harness this energy more effectively. As Benjamin Franklin famously observed, on this health care issue, we hang together or we’ll hang alone.