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by Donald B. Ardell, Ph. D.
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A REAL Wellness Approach To Worksite Health Promotion: Shift Responsibilities (and Opportunities) To Employees (Part Two)

Monday September 10, 2007

In the last essay on this topic, I described a worksite wellness-related idea for lowering employer health insurance costs while improving worksite wellness programming via a shift to REAL wellness programming and a greater stake in remaining well by choosing healthier lifestyle practices. I promised more details in a follow-up piece. This is it. Let's start with a summary of the key elements of my idea.

Three Main Elements of the Proposal
My proposal would entail three major changes. One - a shift in the way companies buy health insurance; Two - reforms in the nature of health promotion education at the worksite; and Three - a shift in accountability for health choices from employers to employees.

Not everyone will like this proposal, but then, not everyone will like any proposed reform to the status quo -- reality does not work like that.

Shift in Who Pays for Health Insurance
The first change proposed is a shift in how companies support health insurance for employees. Let companies pay employees a fixed amount, based upon certain criteria, to buy their own individual health insurance. The companies would offer advice and resources to assist employees buy their own policies, though not all workers would need such assistance.

Reforms in Programming
The second change is to shift the focus of worksite health promotion to REAL wellness. This means education and activities that lead to advances in individual health status. The current programming, by contrast, is upon illness avoidance, medical testing, risk reduction and related programming.

A Shift in Accountability for Employee Health and Illness
The third change is to make employees accountable. This can be done if employers pay employees to look after their own well-being rather than paying health insurance companies to look after the costs of their illness. A great deal of morbidity and mortality is avoidable, based upon poor lifestyle practices. This is the basis for the proposed shift from employer group plans to employee-bought individual insurance, with funds provided to employees by their companies. The key is for the employer to pay workers to seek their own insurance plans. However, this only works if companies also provide significant REAL wellness education and cultural support. Part of the support would be counseling assistance to aid employees select appropriate medical insurance policies.

A number of assumptions, some controversial, underlie and justify this proposal. These include:

The Approach
Companies would pay employees a sum (on par with what they now pay to private insurance companies) with which to purchase health coverage. Employees would use the money to buy their own policies. One advantage is portability, that is, employees could take such policies with them if they change employers, which is not the case under existing arrangements. The biggest advantage is that employees would know that they have a stake in looking after their own health. If they remain well or at least healthier than they have been, they will prosper under the proposed system. If they ignore company provided wellness education and fail to establish and maintain wise health practices, they will pay more. A not-insignificant benefit is to eliminate an impossible-to-sustain burden on employers. Paying for health insurance began in the early 1940's when medical care cost a little bit more than nothing. Today, it is an onerous burden.

In the proposed system, employees will be able to work with health insurance companies to pay only for the benefits they want. In current employer-funded programs, undesired, unneeded coverage policies drive up the costs of protection for everyone. Under my proposal, a company would earmark a sum consistent with what it now pays for health insurance for each worker. The employee could use this sum to pay for whatever insurance plan he/she selected independently. This expense would be deductible for tax purposes (as is health insurance) and, as with the current system, such funds would not be taxable income for the employee, either.

Such programs are already in effect in various parts of the country, but not with wellness educational programming as the foundation element. The latter is the only basis on which the shift in responsibility from employer to employee can be justified. This is the reason I believe employees would benefit as much as employers from the change.

What do YOU think? Am I on to something here? Comments welcomed.


I have urged the National Wellness Institute to include expert commentators as part of every keynote speech at the annual National Wellness Conferences. If commentators provided a critical perspective to the keynoter's points of view, those in attendance would be more likely to think critically about what was communicated by the principal speaker. All would have one or more alternative perspectives to ponder. In short, attendees would be more likely to think than consent. Just because someone is an expert on a given topic does not guarantee that he or she knows ALL the answers or perceives the only or best way to view a given issue.

The same principle seems to apply here. Therefore, I sent a draft of this essay to several reviewers, particularly those I thought likely to challenge the idea and ask tough questions. One of the reviewers, Dr. David Randle, President of the WHALE Center (Wellness Health, And Lifestyle Education), a Senior Fellow at the International Ocean Institute, a consultant to the St. Petersburg (FL) Environmental Research Center and a semi-retired pirate captain who was the first person to obtain a doctorate in wellness from an accredited university, answered the call. Here are a few questions, reservations and/or objections Dr. Randle posed about my idea. I'm also including my brief responses to the good fellow -- all for your consideration and edification. The goal is to stimulate, not to persuade. After all, this entire essay could be a spoof, a plot, a diabolical scheme or something else. What's most important is that you consider possibilities for improving things, in this case, how companies pay for health insurance and the nature of, as well as incentives for, worksite wellness.

Response by Dr. Randle
Don -- I have a few questions that might help you sharpen your thoughts or clarify these ideas. On one hand, I think your plan would be a winner with any corporation, since the flat rate they would pay employees would control costs. Unfortunately, companies would probably do that by giving employees only enough of an allowance to enable the workers to buy cheaper plans than they already have. Thus, unions and many workers would resist, fiercely. Of course, I know you are accustomed to fierce resistance to many of your ideas! Hahahaha.

I think the concept is good if you can work around the obstacles, suggested by the following questions. On the other hand, it might be better to adopt the Canadian model: First provide national health care, then design a wellness plan to complement it.

You sketch three shifts as part of your plan. I have a few questions and comments about each of these shifts.

(Note to the reader: A general response to each of Dr. Randle's questions and comments is provided. My brief responses are shown in parentheses after each question.)

Shift # One

    1. How would health insurance be cheaper if it is bought individually rather in bulk, as companies do now? 
      (Many health insurance plans, I understand, cost more than they would if they did not cover treatments and tests, illnesses and other varying contingencies that some employees don't need or want. With lesser but desired coverage, rates would be lower.) 

    2. How would you transition people from a plan they are in to individual plans and get around the challenge of people no longer being insurable due to pre-existing conditions. 
      (A transition period would be needed, possibly as long as two years, wherein companies would offer two options, the status quo or self-insurance, as herein sketched. Companies would have to carry those workers who prove to be uninsurable.)

    3. If a company gave out a flat rate/allowance, how would it save money with improved employee health practices? 
      (Flat rate allowances would not have to increase, as do health insurance costs to companies every year -- dramatically so, in most cases. The flat allowance would remain, well, flat! Unless, of course, companies chose to give bonuses to employees who became wellness mentors to other employees or otherwise performed in health enhancing ways. The company would also gain, if not save, money if its wellness programs led to healthier, more productive employees, less absenteeism and greater productivity.)

Shift # Two

  1. How is this shift which you, myself and others have been advocating for three decades supposed to happen?
    (A few innovative companies would test it out, work out the kinks and become models for a program that then might be adopted more widely.)

  2. How will this be paid for since in shift 1 the company is no longer saving money on healthy employees, particularly when they were already self-insured? 
    (I don't know, nor am I sure I understand the question. I think a consultant should be hired to study this matter -- and clarify the question.)

  3. Who certifies "Real Wellness" educators? 
    (I do, of course. This is my secret "get rich quick" scheme. However, if that idea does not go over so well, I suppose the NWI can add one more certification course to its growing list of certifications that now constitute 50 percent of attendance at the annual NWC. There are many other possibilities.)

Shift # Three

I think you say it yourself "that it will only work if..." And it is a big if, given that most companies don't have a clue. 
(Yes, "if" and "it depends" are the critical qualifiers for all schemes, including the wise and the hair brained and all in-between. As any self-respecting scholar would probably reply, all this needs further study.)

Thanks. Really good questions. Remember, I covered part of my butt by acknowledging that complexities attendant upon implementation of this idea could not be addressed in a short essay. A cheap trick but necessary for two reasons: 1) space limits; and 2) I have not a clue how to deal with the complications, or even what the complications would be.

Be well. Look on the bright side of life.

Domain: purpose
Subdomain: applied wellness

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