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Wellness in the Headlines
(Don's Report to the World)
Four Recommended Reforms for Worksite Wellness
Wellness programs continue to grow in popularity in corporate America. Most employees enjoy the benefits, especially subsidized and attractive facilities like company fitness centers and classes in topics of interest to them. Organizations offer such benefits because employee participation boosts productivity and exerts a braking effect on the ever-rising expenses of medical insurance.
But, there are problems and some could get worse soon enough. The employees who most need worksite wellness are not the first responders to company offerings. Overwhelmingly, it is the wellest of the well who sign up for the nutrition classes, work and safety lessons, quality of life enrichment options and so on. In fact, the worst cases, that is, employees with the riskiest lifestyles, resist or shun such offerings. Many employees who are obese, who smoke, are sedentary and given to alcohol and other forms of self-abuse, who run up the medical bills (and thus company health insurance costs) care little or not at all about fancy fitness centers and lifestyle classes.
In response, employers have increasingly fashioned negative "incentives" (or disincentives) to the existing menu of worksite wellness. Positive inducements boost participation by the already well enough—no doubt a good thing. But, it often takes a little pain to get the attention and the reluctant involvement of the resisters. Thus, while worksite wellness is generally popular, some parts are not popular at all—at least not with a certain segment of the workforce population. The latter elements also have interest groups who represent their perspectives, so opposition to worksite wellness is increasing at the same time such programs are expanding.
This situation could grow more contentious in the coming years, especially if the Affordable Care Act of 2010 survives next month's Supreme Court rulings. The new law provides significant new funding for worksite wellness—and rules to go with the dollars available. The funds will support employees who meet health status goals as a consequence of their participation in employer wellness initiatives. However, workers who refuse to participate or fail to meet certain goals will almost surely end up paying more for health insurance. Thus, there will be negative financial consequences for some. Those employees who ignore or otherwise do not respond to worksite wellness offerings will suffer. There will be a price to pay for those who choose not to or cannot get off the road to ruin.
Not surprisingly, many individuals and organizations, such as unions, consumer advocate groups and even doctor groups seeking a single payer system like the Physicians for a National Health Program do not welcome a larger role for companies that involves policing employee health.
This situation leads me to recommend four reforms for worksite wellness leaders and others who can shape the direction of wellness programming and policies in the year ahead.
- Do everything possible to encourage quality of life initiatives that promote personal effectiveness. Seek educational offerings that improve decision-making, the use of reason, respect for science and mastery of basic principles of critical thinking. Urge imaginative and enjoyable programs at the worksite that explore timeless mental challenges, such as the nature of and practical ways to achieve added happiness. Promote adult education, such as short courses for employees in practical philosophy. Conducted well, everyone has the potential to enjoy discovering what great thinkers have put forward on such significant topics as ways to discover meaning and purpose in work and life, boost relationship skills, use humor effectively and dozens of other non-medical, not physical forms of human fitness.
- Work to eliminate from the wellness area medical programs. Health-risk assessments and screenings for high blood pressure and cholesterol and so on are indeed important but they are not wellness in nature—they are focused on problem amelioration, not quality of life enhancement. Work to remove such time consuming efforts from company wellness departments—such testing and assessments belong with the doctors and other health care professionals trained to deal with existing and risks of sickness. These two areas have for too long been interconnected, which creates confusion and leads to an over-focus on the medical issues. The latter are familiar, amenable to data collection and non-controversial—and less imaginative and promising than actual quality of life enhancing wellness offerings.
- Guard against incentives that tend to shift heath care costs from the healthy to the sick. A person's health status is not entirely or for the most part a consequence of factors under his or her control. Any of us raised in adverse environments with limited opportunities, afflicted with unfavorable inherited characteristics, would find wellness lifestyles unappealing or too difficult to sustain. We are not agents of our own fate—we are shaped by cultures and a great deal else. Compassion and help for the lifestyle-challenged and others who do not meet desired corporate health goals should become a priority accompanying all wellness programming.
- Work on developing ways to take advantage of Affordable Health Care Act provisions but realize that a more complete overhaul is still needed. Insurance for medical care should be separated from employment entirely. Health care should in America be a government function, as it is in all other Western nations. If the U.S. Congress would expand the current Medicare program for everyone, thus guaranteeing access to basic care for all throughout life, those unfortunate enough to have medical problems would face no barriers to care.
With these four guidelines, companies and other institutions could offer positive incentives without all the unintended consequences that obtain from adding disincentives to the mix.
Two articles for further reading along these lines are recommended: Alan Blinder's "Life, Liberty and the Pursuit of Insurance" (Wall Street Journal, April 20, 2012, p. A13) and Physicians for a National Health Program, "Are workplace wellness programs enough to make you sick?" (Health Policy Brief/Health Affairs, May 10, 2012).
Be well and look on the bright side.
(Ed. Note: Views expressed in this and other columns are those of the author and not necessarily those of the SeekWellness Editorial Board.)
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