It’s true, Big Brother is watching
September 15, 2019 1:12 PM   Subscribe

The case for universal US healthcare is made by eliminating employee wellness programs. Employee wellness programs are increasingly draconian and punitive. Unsurprisingly, employers prize cost-cutting benefits over actual health benefits.

My first post on the blue! Please be kind.
posted by natasha_k (76 comments total) 59 users marked this as a favorite
 
Wow I thought my company’s wellness program nudges were bad but levying fines? Christ.
posted by janell at 1:44 PM on September 15, 2019 [2 favorites]


Yet another good example of why tying healthcare to employment is a bad idea; you can see this comment of mine from a few weeks ago for further evidence of this.
posted by TedW at 2:01 PM on September 15, 2019 [9 favorites]


I’m currently enrolled in a program that puts money into my HSA if I meet certain step goals per day. There’s the 10,000 step goal, of course, but there’s also money for smaller goals during the day. It works out very well for me, since I have a desk job, and the money from that offsets a decent chunk of my insurance premium. However, my wife is enrolled as well. She is moving all day at her job. The 10,000 goal is pretty much automatic for her but the other goals are practically impossible. She gets more steps than I do on a workday and yet I get more rewards. And what if I decide to go do something like take a 20 mile bike ride? No steps there, no rewards. I could take a nice day out at the lake and kayak for three hours; fantastic exercise, no rewards. I guess I can take solace in the fact I’m a hiker so I can get paid a little to hike.

At my previous job, I remember people being offered gift cards to fill out an assessment with health numbers. The next year, employees who took the assessment but who had unsatisfactory numbers were notified that they were going to be penalized significantly on their premiums unless their numbers improved to “acceptable” levels. Right after I left, the assessments became mandatory.

Tying insurance to your job is one of the worst things that could have been done. This was always going to be a consequence of that.
posted by azpenguin at 2:10 PM on September 15, 2019 [56 favorites]


A friend who's still with a company I left many years ago was recently telling me about their "wellness" program. My friend is extremely fit. He doesn't go out of his way to exercise, but he does all sorts of demanding physical work and races a small sailboat for occasional fun. He's a broad-shouldered, tiny-waisted hunk of middle-aged muscle. Somehow their algorithm looks at his height and weight in the dumbest way possible, declares him obese and threatens to raise his whole family's health care premiums, so he's struggling to lose fat that he doesn't have.
posted by jon1270 at 2:33 PM on September 15, 2019 [26 favorites]


Could you tape your Fitbit to a roombas and get your steps in that way? Or put in on the dog's collar?
posted by nestor_makhno at 3:06 PM on September 15, 2019 [10 favorites]


Can I just pre-emptively say that if you're outside the US we already know you have universal health care and pay $5 for surgeries and so on, and yes this is all just as insanely terrifying, baffling, and wrong to most of us as it is to you. We are just kind of trapped under a whirlpool of shit and drowning. I just consider myself super lucky to have been able to opt out of these programs without consequence when they appeared at my old job and they haven't shown up at my new job yet. Just another thing to dread about the future.
posted by bleep at 3:23 PM on September 15, 2019 [57 favorites]


These programs are often extremely dangerous for people with an eating disorder history, a fact HR people have gone to great lengths to not inform themselves or give a fuck about in the slightest. Good think triggering a relapse certainly won't lead to an extremely costly long term hospital stay /s.

There are lots of tricks for defeating the step counters -- I hope people are able to be devious in whatever ways they need to protect their actual health, rather than what insurance companies and HR imagine that to be. It's kind of amusing that they seemingly didn't anticipate everyone going "fuck you" and trying to trick the device, but I guess maybe it's a sort of "we pretend to work, they pretend to pay us" thing where even just having the program at all might get you better insurance rates.
posted by threementholsandafuneral at 3:26 PM on September 15, 2019 [21 favorites]


My workplace has just "invited" us to participate in Go365 but hasn't said anything about penalties. I am unwilling since I am old, in a wheelchair and have chronic conditions that make it unlikely that my numbers will ever improve that much. Just the tracking of number of steps will "prove" that I don't have enough daily activity. Thanks for posting, I'll have to investigate further if I will automatically incur fines for not participating.
posted by a humble nudibranch at 3:29 PM on September 15, 2019 [5 favorites]


RE: tricking the device, how can they tell you are actually stepping and not, say, cheating with a mechanical aid? Or is it literally just *shrug* here’s the money anyway?
posted by darkstar at 3:39 PM on September 15, 2019


nestor_makhno: Could you tape your Fitbit to a roombas and get your steps in that way? Or put in on the dog's collar?

Dog collars don't work all that well. Attaching it to a drill bit, on the other hand...
posted by cowcowgrasstree at 3:41 PM on September 15, 2019 [7 favorites]


Are these programs administered by doctors? If not, wouldn’t they fall under the existing laws for inactivity medicine without a license since these are giving health advice with serious pressure to follow it?
posted by adamsc at 3:46 PM on September 15, 2019 [5 favorites]


Tying insurance to your job is one of the worst things that could have been done.

Also up there is a system full of private insurance in the first place, with people profiting wildly off of denying care to people who need it.

This should not be allowed.
posted by entropone at 3:48 PM on September 15, 2019 [19 favorites]


Could you tape your Fitbit to a roombas and get your steps in that way? Or put in on the dog's collar?

Most fitness trackers measure "steps" using an accelerometer. My old (very low-budget) wrist-worn fitness tracker would give me credit for "steps" if I did anything that involved waving my hand about, and then wouldn't give me credit for the actual steps I took in the grocery store because having my hands on the grocery cart push-bar kept the tracker too steady.

Newer fitness trackers have heart rate monitors built in which is probably harder to game and also potentially very invasive for both obvious and less obvious reasons.
posted by Secret Sparrow at 3:53 PM on September 15, 2019 [5 favorites]


My friend's company puts employees onto "teams" and teams have names and leaders and published scores that show how many steps each team has completed.

You can imagine how enthused people are to be talking about how well their team is doing and having discussions with their leader about whether their contributions are stacking up.

Aside from what this does to morale, one can't help but suspect it is all about the 3rd party Fitbit companies tracking and selling behavioral data.
posted by xammerboy at 3:55 PM on September 15, 2019 [7 favorites]


The Fitbits also measure how much sleep you're getting, the quality of that sleep, your heart rate, where you've been when, and all kinds of other data which can be sold or used by HR to terminate an unhealthy or what they deem to be risky employee.
posted by xammerboy at 3:57 PM on September 15, 2019 [14 favorites]


how can they tell you are actually stepping and not, say, cheating with a mechanical aid?

They don’t care if you’re cheating until you actually need health care, at which point they establish the cheating and revoke your insurance? So really they want everyone to cheat and not worry about it enough to hide it.
posted by clew at 4:21 PM on September 15, 2019 [19 favorites]


Are these programs administered by doctors? If not, wouldn’t they fall under the existing laws for inactivity medicine without a license since these are giving health advice with serious pressure to follow it?

This is what I don't understand about these as well. My ex had me enrolled in one because I was on his insurance so we both had to do it. I have a mental illness I've known about since I was in high school and was in treatment for. I didn't lie about whether I ever felt "depressed" etc on the questionnaire because I knew I would probably be receiving care and treatment for it under this insurance plan. So I answered honestly and they never asked about actual treatment but wanted to have a phone call with me to talk about my answers or else my enrollment in the "wellness program" wouldn't count. So they basically tried to talk to me about exercise and shit and I had to say "look I have a diagnosed mental health condition that I receive medical treatment from a doctor for, this is totally inappropriate" which honestly, I didn't even want to have to talk about with a stranger and would not have done at all but my ex was pretty adamant that I enroll because he got a discount if I did.

Incidentally, that ex also had a health condition that he had to have major surgery for while enrolled in this program and there was no way he would have been able to meet their "step requirements" but he figured out there was a way to manually enter them somewhere, so that's what he did to get around it.
posted by primalux at 4:38 PM on September 15, 2019 [9 favorites]


I used to work in a print center where a coworker would put her Fitbit into the paper jogger for 20 minutes or so, to get a "walk" in while working. Hope this tip will help someone cheat their BS wellness program.

Burn it all down, smash capitalism, etc.
posted by captain afab at 5:08 PM on September 15, 2019 [22 favorites]


I think I'm paying about $700/year more in insurance premiums than my colleagues who agreed to sign up for the employee wellness program. For folks with families, I think the penalty was something up to $2000/year? (This is all framed as getting a discount for signing up for the program, but we know what it really is.)
posted by pemberkins at 5:43 PM on September 15, 2019 [11 favorites]


I don't know if we'll get universal health care but I do know that we could reverse the gutting of unions. You can talk all you want about the structural reasons for the weakening of unions but I'll point you to the massive amount of energy that's been spent in the legislature and the courts fighting unions. Who knows if we'll ever get a socialist utopia but we have to have a tool to fight for our dignity.
posted by rdr at 5:46 PM on September 15, 2019 [18 favorites]


I was interviewing with a company a few years back and happened to pick up an employee newsletter while waiting for the interviewer in the lobby. There was an article describing the wellness program: if you underwent biometric screenings and a health risk questionnaire, you got $500 off your premiums. Sounds fairly typical but then...based on the results of those things, you would be given a health-related goal and a year to achieve said goal. If you did, you got another $800 discount off your premiums. That just seemed horribly invasive to me and I was kind of glad I didn't get hired.
posted by SisterHavana at 5:55 PM on September 15, 2019 [6 favorites]


So they're not allowed to use the information they already have through an individual employee's use of the health care plan, so they request it like this instead?
posted by Selena777 at 6:04 PM on September 15, 2019 [5 favorites]


Support unions, yes. But be aware, unions have been one of the obstacles to M4A, because being on their health plan is one of their selling points for recruitment.
posted by hypnogogue at 6:18 PM on September 15, 2019 [2 favorites]


The union I was in had one of these, too. That said it was pretty sensible, you got the "discount" if you had your annual checkup and blood work, went to the dentist every six months, and went to the eye dr, and gynecologist (if relevant, not sure what the alternative option if not relevant was).

Now that I'm not in the union and on the employer's plan, the options are way more invasive. I could let them read my fit bit, and my grocery store rewards card! Or talk to a health coach or see a nutritionist. The assumption seems to be that I must have a health problem I'm working on. It creeps me out and I refuse to participate.
posted by sepviva at 6:28 PM on September 15, 2019 [4 favorites]


Wasn't it the unions' fault that we have employer-sponsored health insurance in the first place? Will the master's tools dismantle the master's house?
posted by Hal Mumkin at 6:32 PM on September 15, 2019 [2 favorites]


The assumption seems to be that I must have a health problem I'm working on.

Or that if you have a health problem it's probably your own fault for not exercising, eating "right", etc...
posted by primalux at 6:37 PM on September 15, 2019 [9 favorites]


Can I just pre-emptively say that if you're outside the US we already know …

I got a fairly sweet pair of wheels out of an employer's wellness plan in Canada. They tried to have all of these incentives for signing up, but most of them would break Canadian disclosure laws. They did offer up to $1000 grant for a bike, and its deadline for claims coincided perfectly with the last year's model sale at a local dealer. I got a ridiculous 29er out of the deal.

The fuckers fired me while I was on vacation the next year, though.
posted by scruss at 6:58 PM on September 15, 2019 [4 favorites]


Wasn't it the unions' fault that we have employer-sponsored health insurance in the first place?

Invoking Betteridge's Law, the simple answer is "no."

During WWII there was a shortage of workers because millions were at war overseas. Because of the shortage of workers, businesses were forced to raise wages in a bid to attract workers from other competing businesses. To prevent wage inflation, the Stabilization Act was passed in 1942 freezing wages and prices. Businesses invented employer health insurance as a work around the wage freeze. The wage freeze law prevented them offering higher wages but it didn't prevent them from offering health benefits instead.

After the war, the precedent had been set that compensation consisted of both wages and health benefits so unions negotiated on that precedent.

You can blame WWII and you can blame an ill-advised wage freeze and you can blame competing business owners, but it is just weird to blame unions. They didn't create the rules.
posted by JackFlash at 6:59 PM on September 15, 2019 [37 favorites]


Support unions, yes. But be aware, unions have been one of the obstacles to M4A, because being on their health plan is one of their selling points for recruitment.

This is a mischaracterization of the situation. Most unions have publicly backed M4A. Some of the older unions like the UAW have not, and for good reason. They sweated blood to earn their health benefits, often with long, debilitating strikes. They often negotiated better health benefits in lieu of higher wages, giving up salary. As a result their health insurance is better than most.

Given the vagueness of all of the candidates' M4A policies, they are reluctant to give up their hard earned health benefits for some ill-defined replacement. They could end up poorer as a result.

If you want these holdout unions to support M4A, candidates need to demonstrate they won't be screwing them.
posted by JackFlash at 7:16 PM on September 15, 2019 [15 favorites]


Is there a way to force employers of union workers to have to renegotiate contracts as a part of M4A? Then they could claw back the money the employers had been spending on their health insurance.
posted by Weeping_angel at 7:29 PM on September 15, 2019


I'm also against Medicare for all too for basically the same reason, Medicare sucks. Fixing and improving Medicare has to be a part of it. We deserve better than the best not this shambling mess.
posted by bleep at 7:39 PM on September 15, 2019 [2 favorites]


Is there a way to force employers of union workers to have to renegotiate contracts as a part of M4A?

Sure. Here is Bernie Sanders' platform: "if Medicare for All is signed into law, companies with union negotiated healthcare plans would be required to enter into new contract negotiations overseen by the National Labor Relations Board."

"Under this plan, all company savings that result from reduced healthcare contributions from Medicare for All will accrue equitably to workers in the form of increased wages or other benefits."

But talk is cheap. We are a long ways from M4A, let alone one that has a special carve out for unions. Meanwhile some of the unions are going to be wary.
posted by JackFlash at 7:42 PM on September 15, 2019 [1 favorite]


They often negotiated better health benefits in lieu of higher wages, giving up salary. As a result their health insurance is better than most

So they're no better than the capitalists they're fighting. Burn them all, replace them with some actual solidarity over "fuck you, got mine" writ large
posted by CrystalDave at 10:45 PM on September 15, 2019 [1 favorite]


Wait, are you seriously blaming unions for negotiating in their members' interests?

Look, in the long term it's probably going to turn out that it was bad idea to trade pensions and health care for lower salaries but in an era of of stable companies it made sense. Now, not so much.

My original point is that unions are the best tool to stop companies from endlessly expanding their control over their work force. They aren't a perfect tool. The university I work for has wellness programs but there's no punitive measures built into the system and there won't be as long as the university wants it's trash collected, labs cleaned, hospital staffed, paperwork shuffled, facilities maintained, etc.
posted by rdr at 12:29 AM on September 16, 2019 [8 favorites]


Okay, file this idea for when you get Universal Healthcare, but a nice side effect of not allowing insurance companies to deny certain care, and to not allow insurance companies to reject people who want to be their customer: insurance companies here (in the netherlands) are offering free assistance to quit smoking to people who want to do that. If it's in their interest to keep you healthy in the long term, they will actually do so.

I totally understand questioning the incentives of companies to muck about with these programs. I just want to remind you that turning the incentives around can be a good thing.
posted by DreamerFi at 1:12 AM on September 16, 2019


Some of the older unions like the UAW have not, and for good reason. They sweated blood to earn their health benefits, often with long, debilitating strikes.

Solidarity for never.
posted by This time is different. at 4:23 AM on September 16, 2019


Just popping in to retell my story, and remind you that they can make you undergo the screenings/wear the gizmo/whatever other horrible thing, but they can't make you give accurate data. When I got stuck doing one of these a while back, I inadvertently discovered the trick to setting the bar low: show up to the mandated health screening on 90 minutes of sleep, hypercaffeinated and with your blood sugar and blood pressure obliterated by the thing of chocolate-covered coffee beans you just ate to stay awake through the 9AM meeting. They can't PROVE it's not your actual baseline, so...
posted by Mayor West at 5:12 AM on September 16, 2019 [12 favorites]


I'm sure there are cheaper ways to game the pedometers, but a co-worker arrived at work one morning to find he had already done 25000 steps, thanks to his commute on his old Harley-Davidson.
My current workplace has in the past offered discounts for actually doing the preventative care things that were already covered at 100% in the plan (like and annual check-up). More recently, they have required participation in health monitoring stuff as well to qualify for the discount. No, thank you.
posted by coppertop at 5:46 AM on September 16, 2019


I worked for a hospital that had a bullshit insurance wellness program - if you did a health assessment and then submitted daily check-in data for healthy eating/exercise/sleep efforts, you could get gift cards to Target or Home Depot or other big box stores. You could enter data retroactively, so I would log in once a quarter, submit a month’s worth of fake data in 10 minutes, and then get a gift card in the mail. I was renovating my basement at the time and paid for a lot of paint that way.

On the other hand, my current local government job wellness program is actually really good. You have to complete 3 activities to get a $15 copay reduction for doctors office visits, but the activities don’t involve submitting any personal health data (unless you want to sign up for the health coaching program). My 3 activities this year were a free flu shot, a lunch hour intro to meditation, and another lunch hour seminar on winter biking (led by a hard core cyclist from the transportation planning department). Once I did a lunch hour seminar on meal planning, which was ridiculous because it was tailored to middle-aged Minnesotans to include “hot dish” (casserole) and meatloaf on your monthly meal rotation (PUKE PUKE), but other people seemed into it. If you do 5 activities you can get a $3 coupon every week for fresh produce at the seasonal farmers market nearby, plus a card that gets you $5 off produce per week at local grocery stores. You can also count participation in 5Ks or other organized running/bike races as one or more of your activities, or self-report other ongoing exercise.

When done well, with sufficient organizational infrastructure behind it and rewards that improve access to healthy food, wellness programs can be a positive thing.
posted by Maarika at 7:52 AM on September 16, 2019 [1 favorite]


My friend is extremely fit. He doesn't go out of his way to exercise, but he does all sorts of demanding physical work and races a small sailboat for occasional fun. He's a broad-shouldered, tiny-waisted hunk of middle-aged muscle. Somehow their algorithm looks at his height and weight in the dumbest way possible, declares him obese and threatens to raise his whole family's health care premiums, so he's struggling to lose fat that he doesn't have.

Sounds like your friend has an excess of yellow bile in his humors - or rather, that he’s being held hostage to his BMI, an equally nonsensical form of pseudoscience.

Here’s a list of 10 reasons why BMI is bunk. The short version is that it’s a population-level metric that’s applied to individuals (hello, ecological fallacy!) and that... even as a population-level metric it has zero scientific validity. If your measure of obesity can’t distinguish between muscle and fat, it might not be very useful!

Basically, you can treat BMI with the same degree of seriousness that you would treat a quiz in Cosmo (“mostly A’s: your insurance premiums will go up”) and anybody who uses BMI while claiming to be a healthcare professional should be understood to be a quack.
posted by chappell, ambrose at 7:52 AM on September 16, 2019 [10 favorites]


So doctors should use body fat percentage instead?
posted by Selena777 at 8:04 AM on September 16, 2019


Well, I'm going to attempt to wade the apparently dangerous waters of supporting the notion that promoting healthy living is a pretty good idea. All societies, even those with public health care can benefit from a healthier populace. There's any number of benefits associated with people living healthy lives.

And we encourage these efforts on a wide scale in any number of ways such as banning soda from schools, spending public money on bike lanes and building public pools.

While I agree that the article does an excellent job pointing out the dangerous pitfalls of the practical matter of rewarding 'healthy living' and penalizing 'unhealthy living', I think the idea that people who look after their health cost society (and private health care) less than people who don't is fundamentally true and that we should be creating incentives for people to be more healthy.

Now, there's a million ways that these efforts can go wrong, but I disagree that it's the wrong path, we just need to pave over the potholes.
posted by Phreesh at 8:53 AM on September 16, 2019 [1 favorite]


Except they're not doing it for the public benefit they're doing it for greed. That automatically disqualifies them from getting the benefit of the doubt. There are ways to encourage public health and it's more along the lines of paying for the medications people need and letting them take time off when they need it. Enforcing arbitrary blanket requirements of footsteps etc on the general public is stupid & harmful.
posted by bleep at 9:13 AM on September 16, 2019 [14 favorites]


Now, there's a million ways that these efforts can go wrong, but I disagree that it's the wrong path, we just need to pave over the potholes.

The potholes are capitalism, and the article is about one of the million ways these efforts can and have gone wrong. As soon as we figure out a way to pave over for-profit businesses making money off of health care premiums, and incentivizing other companies to be total rent-seeking assholes to their employees who depend on employer-provided healthcare, then maybe we can talk about incentivizing wellness. Until then, we should focus on burning insurance companies to the ground and salting the earth where they stood.
posted by Mayor West at 9:20 AM on September 16, 2019 [8 favorites]


I think the idea that people who look after their health cost society (and private health care) less than people who don't is fundamentally true and that we should be creating incentives for people to be more healthy.

Also this idea that being healthy isn't it's own reward is bizarre. Like we owe our strong healthy bodies to some corporation who knows more about it and values it higher and needs it more than I do. It's a really harmful idea. Not being healthy is an awful thing to have happen to *you*, not to whatever dumb ass you have to work for.

The thing about Medicare for all that scares me is that it still operates on the theory that healthcare is a privilege and not a right and so does this idea that a healthy functional body is yet another thing *we're* required to provide to society no matter what it costs us. It's the other way around. Unfortunately for all their faults unions are the only institutions we have that see healthcare as a right and if they win that for their members it becomes normal, that means more of everyone else gets to enjoy it too just like weekends and 8 hour days.
posted by bleep at 9:47 AM on September 16, 2019 [5 favorites]


My entire adult life has been dominated by health insurance companies deciding everything about my life and how much me and my husband have to suffer and how much treatment they will allow and what treatments they won't allow. There was no amount of footsteps we fell short of that would have prevented us from needing and being denied care. What about all the people dying because they can't access insulin anymore. What "incentive" did they need to stay alive?
posted by bleep at 9:53 AM on September 16, 2019 [9 favorites]


While I agree that the article does an excellent job pointing out the dangerous pitfalls of the practical matter of rewarding 'healthy living' and penalizing 'unhealthy living', I think the idea that people who look after their health cost society (and private health care) less than people who don't is fundamentally true and that we should be creating incentives for people to be more healthy.

Awesome then they should give me time off work to exercise and shop for/prepare healthy meals which would be the best possible thing for my health. Instead, my spouse and I get up at 5:50, get our kid to daycare and ourselves to work, get home around six and need to cook dinner immediately, then put the kid to bed and, in theory, be asleep by 9:50 to get a full, healthy eight hours of sleep. I would LOVE to exercise more but I am constantly exhausted and there just isn't enough time. This is just a way to put the costs of "health" on individuals instead of holding workplaces accountable for the amount of time they expect from employees. If you want me to live a healthier life please ask my employer to shorten my workday so that I might do so, thank you.
posted by an octopus IRL at 10:19 AM on September 16, 2019 [26 favorites]


"Well, I'm going to attempt to wade the apparently dangerous waters of supporting the notion that promoting healthy living is a pretty good idea."

The problem is unnecessarily tying the entire thing to employment in a way that lays bare the dysfunctionally paternalistic relationship that bore our modern health care system.
posted by Selena777 at 10:27 AM on September 16, 2019 [3 favorites]


My workplace has one of these wellness programs, and currently all it takes is a signed paper from your primary care doctor saying you're following the doctor's advice about being healthy. No BS trackers/logging. If they moved to that, I'd debate joining. AFAIK they never even verify the doctor paperwork. It comes with an insane $1300/year discount on our insurance, so it's worth the work.

Also, FWIW, if you have a Fitbit, you can login to their website and manually log any exercise you want, giving the number of steps or distance or whatever. You can give yourself 1,000,000 steps a day and it doesn't really care.
posted by msbutah at 11:42 AM on September 16, 2019 [1 favorite]


I guess I'd respond with a yes and no.

As a Canadian, I don't face the same troubling 'Big Brother' aspects of my employer knowing the intimate details of my health or the paternalistic relationship that employers have with employees. It's poisonous and raises a number of troubling questions - I agree.

But, also as a Canadian, I see a significant chunk of my tax dollars going to health care expenditures.

The best way to avoid these costs is obviously prevention, but this requires (well, at least benefits from) incentives for people to live healthier lives. Most everyone has looked at the programs outlined in the article as penalizing the unhealthy, but they can easily be looked at as rewards for the healthy.

That's kind of how it is in Canada. Right now, I have to pay taxes to look after people who haven't looked after themselves (And also people, who through no fault of their own end up in the hospital, but the largest proportion consists of avoidable 'life choices'). Those costs are not insignificant.

It would be nice to be rewarded for my efforts to live a long, healthy life. And Canada as a whole could reap enormous benefits if we lowered our health care bills. Sure, we could say that it's unfair that 'healthy' people could pay less taxes than 'unhealthy' people, but (assuming the decisions are based on science) the tax incentives would be directly correlated to the health care costs avoided by being healthy.

The alternative is to shove your head in the sand and have people who make unhealthy choices be subsidized by those who do and that's fundamentally unfair.
posted by Phreesh at 11:57 AM on September 16, 2019


That's kind of how it is in Canada. Right now, I have to pay taxes to look after people who haven't looked after themselves (And also people, who through no fault of their own end up in the hospital, but the largest proportion consists of avoidable 'life choices'). Those costs are not insignificant.

Hey man, if you don’t like it you can always leave. National health systems don’t work if healthy people check out of them, because the entire point is to pool risk. But it really sounds like you’d feel more comfortable in a fully private system, like the US. (Coincidentally, if you lived there you might be able to usefully address the subject of the thread, which is what everyone else is discussing.)
posted by chappell, ambrose at 12:23 PM on September 16, 2019 [6 favorites]


"But, also as a Canadian, I see a significant chunk of my tax dollars going to health care expenditures."

How much would you say you pay annually for national health care?
posted by Selena777 at 12:30 PM on September 16, 2019 [4 favorites]


That's pretty simplistic. National health systems are subject to improvement. And I've already pointed out that society recognizes that promoting fitness and health is worth spending tax dollars on. Programs that reward healthy behaviour to individuals is merely and extension of that.

Anyway, I see a lot of discussion about how disgusting it is that people should have to pay for their life choices. I think that it's fair that people have to account for them. Now, lots of folks have pointed out that this attitude can be unfair and also presents many drawbacks, but I also think it's close-minded to wholly dismiss the idea that a healthy person costs both a national health system and private health care company real money. I think it behooves everyone to recognize that and find ways to incent healthy behaviour while trying our best to identify and avoid the pitfalls associated with such measures.
posted by Phreesh at 12:32 PM on September 16, 2019


Selena777. Thousands. Maybe something like $10,000. Probably more. How much do I have to pay until I'm allowed to have an opinion?
posted by Phreesh at 12:36 PM on September 16, 2019


Being healthy is it's own reward. If you're healthy right now you should get down on your knees and thank whoever you thank for your good fortune and leave everyone else alone.
posted by bleep at 12:37 PM on September 16, 2019 [6 favorites]


No one stays healthy forever, that's just how it is on Earth.
posted by bleep at 12:39 PM on September 16, 2019


Well, yes. I am truly thankful for my health, but I'm also interested in how we can best encourage an entire society to seek good health. One idea is to provide tax incentives to people who undertake healthy activities or who can demonstrate that they meet certain scientifically-derived 'health benchmarks'.

How do you think a free society could get people to take action to be more healthy? Under a private system, do you think there's a fair way to reward people who take their health seriously?
posted by Phreesh at 12:48 PM on September 16, 2019


The alternative is to shove your head in the sand and have people who make unhealthy choices be subsidized by those who do and that's fundamentally unfair

That's not fundamentally unfair, that's fundamentally the point of every social insurance scheme. People whose lives aren't currently all fucked up are subsidizing what unfucking their society can manage for the people whose lives are fucked up right now. Because having your life be fucked up sucks donkey balls, because various kinds of fucked-up-edness can be managed or ameliorated, and because it might be your life that gets fucked up next week.

Beyond that, the thread is about the American health care system, not any of the Canadian provinicial systems or any other proper health care system. Honestly, if you have not ever had to live in the vicious nightmare world of American health care, you lack the basic information needed to usefully reply to this thread. No doubt there could be another thread about wellness systems and incentives under OHIP or under the French system, which might not be Orwellian horrors because those health care systems actually give a crap about the health of their citizens instead of being, again, vicious nightmares. The ones here are Orwellian horrors, because they are part of the American health care system. They could not ever be anything else.
posted by GCU Sweet and Full of Grace at 12:52 PM on September 16, 2019 [8 favorites]


I was just curious about how much it could be per person when separated from employer subsidy - our domestic discussions about the prospect of universal health care tend to elide it. Canadians are healthier than Americans - what would be the desirable national benchmark to shoot for?
posted by Selena777 at 12:54 PM on September 16, 2019


It would be nice to be rewarded for my efforts to live a long, healthy life.

One study found that the most expensive group in terms of lifetime medical costs was actually healthy, never-smoking individuals because they lived the longest.

Younger, healthier people will be the ones subsidizing your medical care when you're old and sick. You should be glad to be one of them now.
posted by mosst at 12:56 PM on September 16, 2019 [5 favorites]


Well, again, I would agree that I have many things to be grateful for, including being born into the Canadian health system, but I don't think that precludes me from considering how things could be improved.

And I also understand how insurance works. But, let's use an extreme example to help me make my point. Let's say that I have insurance on my car. Let's say my insurance company specializes in selling insurance to blind people (and also some sighted people). Now, all those blind folks tend to get into a LOT of accidents and my rates keep going up to pay for all those accidents. Now, should I, as a non-blind person a) be happy to pay my massive premiums because I may end up blind some day and will have sighted people to pay my insurance so I can drive or should I maybe b) change insurance providers or c) try to work with the insurance company to improve their policies?

I recognize this is a ridiculous example, but I'm try to point out that a flawed system can be improved. Just because one solution has some obvious obstacles doesn't make it a terrible idea, it just makes it a difficult one. At the end of the day, maybe the downsides outweigh the benefits, but I don't see the benefits being given any thought in this discussion.

And I want to underline that this isn't a personal attack on anyone. I get that people experience health problems for a million reasons beyond poor life decisions. I am experiencing such a setback right now. Shit happens and in the US in particular, you get screwed, I just think this is a very interesting and important problem.

Health care costs are climbing and we need to find creative solutions to curb them. There are lots of good and bad ideas out there to address this. I think one potentially good idea is to reward healthy behaviour, but, as abundantly noted above, there are a lot of pitfalls. Is this a fundamentally impossible idea or is it a decent idea that needs work?
posted by Phreesh at 1:14 PM on September 16, 2019


Your example only works if you are *guaranteed* to become a blind person. Everybody gets sick.

Listen, I'm a Canadian who lives in the States now (moved here at 30; I'm 45 now) and who works in healthcare. I can see the point of wellness programs. They have one at my workplace which is used for education, which is great - the only lifestyle choice they penalize is smoking tobacco. It's not like there can't be good wellness programs. But US employers take advantage of their workers in ways that are just jaw-droppingly, stunningly *unbelievable* if you come from Canada, and the laws to stop them either don't exist or aren't enforced. There's a reason that a child born to poor parents in the US is twice as likely to remain poor throughout life than a child born to poor parents in Canada. The system is basically set up to grind people to dust.
posted by joannemerriam at 1:26 PM on September 16, 2019 [6 favorites]


Encouraging public health, as government policy, is fine. Both because it probably saves health care money, but also because it promotes the general welfare.

This is, however, not what this discussion is about.

This discussion is about “wellness programs” in the United States, in which your company hires a third party, who is different from the third party that provides health insurance, and has them access and/or track your personal information for unclear reward (money in a health savings account, or reduced deductible, but the actual value is often hidden behind “points” systems.) Often this involves some sort of intrusive and/or stupid “coaching” requirement, in which a call center employee without medical training tells you you should exercise. Or connecting a Fitbit so the wellness company can track your location and/or heart rate all day long.
posted by Huffy Puffy at 1:27 PM on September 16, 2019 [11 favorites]


Phreesh, the very fact that you're coming at this from the point of view of trying to help with something means that you at base do not get the baseline viciousness of the nexus between American employers and American health care. You are talking about a system where a reasonable response to an employee's child getting cancer is to fire the employee so next year's health insurance bill doesn't increase.

This is not a good place for a neutral discussion of how to encourage wellness, because these systems are not about encouraging wellness. They're about forcing people off your health insurance, or driving them away from your insurance with onerous requirements, or collecting data on your employees to learn how better to take away what time and energy they uselessly devote to themselves and their families.
posted by GCU Sweet and Full of Grace at 1:46 PM on September 16, 2019 [11 favorites]


I was recently diagnosed with sleep apnea, and discovered that in exchange for insurance agreeing to pay for a CPAP, they require the submission of "compliance data" proving that you're actually using it. My insurer requires 10 months of this. Given that it collects some rather detailed information about when and what quality of sleep I'm getting, that sketched me the hell out and I'm pursuing alternatives. I would strongly prefer my medical devices to not be internet connected, thank you.

I'm sure as hell never giving my employer my health data, and I'm thankful that I'm in a position that allows me to not need the financial incentives offered, if that were something my employer did.
posted by vibratory manner of working at 2:48 PM on September 16, 2019 [2 favorites]


I think more fundamental change in health care access, aside from tinkering, will have to be driven by individual states. Some state (e.g. California) is going to be the first to offer a true public option. And then once it’s so popular, that state will then convert it into a state-level M4A.

And once that happens, and workers and businesses realize the advantage of working and living in that state, other states will start to develop their own public options in order to compete for jobs and taxpayer base.

I’m hoping that we as a nation can manage it all in one go, but like gay marriage rights, it’ll probably have to be piecemeal until momentum develops.

(For that matter, similar to the Medicaid expansion under the ACA.)
posted by darkstar at 2:49 PM on September 16, 2019 [1 favorite]


But government in Canada does try to make laws/policies to improve health. Ontario stopped coal power generation and one of the main reasons for doing so was the projected decrease in respiratory diseases. We have high taxes on cigarettes to discourage smoking and help pay for the health costs associated with it and we also ban tobacco advertising. I could believe that in the future a provincial government will look at the health costs associated with air pollution and long driving commutes and modify its planning laws accordingly.
posted by any portmanteau in a storm at 2:59 PM on September 16, 2019 [1 favorite]


One thing I always wonder is whether these actually save employers any money, even in medical costs. If formerly sedentary people start exercising, they could stave off adverse health issues in the future, but who knows if they'll even be with the same employer by the time that's relevant.

And in the immediate term, they're probably more likely to sustain minor injuries related to the exercise?
posted by smelendez at 4:55 PM on September 16, 2019


I sorta think it's silly to assume literally anyone isn't doing all they can in terms of wellness. Given constraints of time and money and mental health and environment and access to treatment and knowledge and skills, even the most addicted person is doing the best they can to keep themselves above water. Sometimes short-term okayness outranks life-long okayness in ways that are super unhealthy long-term, but everyone I've ever met is trying to get to or stay okay, at the very least.
posted by lauranesson at 6:08 PM on September 16, 2019 [5 favorites]


And shouting at people who "aren't taking care of themselves" overlooks so many structural problems in an American context that it gets to class and race divides in like 2.4 seconds.
posted by lauranesson at 6:10 PM on September 16, 2019 [9 favorites]


I’m going to communicate this as simply and kindly as I can, and then I’m going to walk away from the thread for a while.

The ‘car insurance company’ thought experiment is steeped in ableist attitudes. It starts by using a disability as a prop, and then uses that prop to cast people who need health care as villains making risky choices and taking unjustly from their fellow citizens.

Regardless of intent, these attitudes are harmful. Please try to do better.
posted by FallibleHuman at 9:33 PM on September 16, 2019 [7 favorites]


Awesome then they should give me time off work to exercise and shop for/prepare healthy meals which would be the best possible thing for my health.

QFT.

One of the absolute nadirs of working at my firm came a few years ago when the firm gave everyone a copy of You: On a Diet while I was working on a horrendous stressful project that took up the vast majority of my day.

Seriously they were telling me that

1) I had to work 55-60 hours per week
2) The majority of that had to be on-site (even though I was supporting a group 3 time zones away and could have managed all of my tasks remotely, every single day.)
3) The firm would buy dinner for me and my teammates, which was mostly pizza.
4) I was in by 8 am and sometimes didn't log off until after 10 pm.

AND with the gift of the book, they were telling me that I needed to make time for a one-hour walk every day plus making healthy meals for myself. I barely had time and energy to put my clothes out in the evening and take a shower in the morning.

If they really cared about my health, they could have

1) Added more team members and broken the shifts up, so nobody had to work extremely early or late
2) Allowed us to work from home, which would have freed up 1.5 hours a day for me that I could use for exercise and cooking
3) Provided healthier meals for the team

But 1) and 3) would cost more money than the damned book, and 2) would violate some unspoken office politics rule, so I was stressed and depressed and suffering from insomnia (from having to work so late at night) and sleep deprivation (from having to wake up early to commute in). It was so much easier for them to shove a book at me and pretend that they cared about my health.

The only petty solace I have is that I'm not on their health insurance, so they wasted the cost of the book on me, and they cannot force me to participate in their wellness program.
posted by creepygirl at 9:53 PM on September 16, 2019 [5 favorites]


I’m going to communicate this as simply and kindly as I can, and then I’m going to walk away from the thread for a while.

Interestingly, I feel this thread is full of the liberal parallels of why conservatives don't like or want socialized medicine. It's bureaucrats, socialized (instead of individualized) choices, and monitoring from a group you don't personally like or trust all the way down.
posted by The_Vegetables at 7:27 AM on September 17, 2019


At least in a socialized system you don’t change national governments every year and have to register for yet another different set of providers, with different rules, which may or may not actually have their shit together enough to provide service by the start of the year.
posted by Huffy Puffy at 7:35 AM on September 17, 2019 [3 favorites]


I want to know why businesses, large and small, are not full-throatedly supporting M4A or some correlate. What a great savings for every business! It doesn't make sense that this isn't part of the debate to me. They wouldn't have to create a bureaucracy for these crazy "wellness" plans, they wouldn't have to have a huge HR system to implement insurance etc. Someone tell me why this isn't part of the conversation.
posted by Belle O'Cosity at 7:16 PM on September 17, 2019 [1 favorite]


I want to know why businesses, large and small, are not full-throatedly supporting M4A or some correlate ... Someone tell me why this isn't part of the conversation.

Well, other than the fact that CEOs are genetically predisposed to hate anything that smells like socialism, they also like the idea of a workforce that is desperate to keep their jobs because of their fear of losing healthcare.

Holding healthcare hostage to your coming to work everyday is to their advantage. It is even a stronger incentive than cash. Fear of losing your wage is one thing but fear of overnight becoming in debt by hundreds of thousands of dollars is highly motivating.
posted by JackFlash at 8:02 PM on September 17, 2019 [3 favorites]


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