Show Me the Money

Something that has been bugging me for a while turned up on 60 Minutes tonight. They ran a story about people who were fired from their job because they wouldn't quit smoking. Not because they were smoking at their desks, or because a co-worker or a customer had complained, not even because they were smoking at work. Just because they wouldn't quit, period.

It turns out to have nothing to do with job performance and everything to do with the bottom line. Companies that provide health insurance for their employees pay a higher premium if they have employees who smoke.

The story went on to show several other companies that had put in place "wellness programs" designed to modify the behavior of employees toward the end of reducing health care costs. These programs were not just about smoking, but also about diet, exercise, and sexual behavior. The programs require participants to fill out a lifestyle questionnaire and then have follow up drug tests, polygraph tests, and even a "lifestyle nagger" who calls people up to ask them what they've been eating and whatnot.

The way things are going, it would seem inevitable that nearly every employer with a substantive number of employees will put such a program in place. My employer this year radically restructured our benefits. I wonder how long it will be until someone calls me to ask me when the last time I went to McDonald's was, or how long I am sleeping.

Never mind that my lifestyle is 90% a manifestation of my job and job stress. Perhaps they ought to ask that in their questionnaire.

One employer on the show was lamenting how much it sucks that he can't extend a mandatory smoking ban to spouses of people that work for him.

Here's the problem for me. I think these employers are within their purview to enforce such plans. Medical costs for employees are a business expense for them, and just like they would try to save money anyplace else, why should the benefits program be off limits if there are savings to be made.

Curiously, they are able to make a societal change here that doctors, schools, insurers, or government can't. They are able to say "you must change." All the other mentioned bodies can't drop someone for poor behavior in any kind of a final way. Public institutions can't do that. Private ones can.

Naturally, the terminations have been litigated. It turns out that in most states it is completely legal behavior to fire someone over completely legal behavior. So not only is it good business sense, but it is also within the law. For the moment.

Because of course now that politicians have seen the problem, and since this is a great case for the little guy, there is talk about trying to make this kind of practice illegal. I have a better idea.

Let's divorce health insurance from work.

Why it seemed like a good idea to have health benefits at your job is beyond me. It leads to all kinds of privacy breaches. It makes people hate their employers when they otherwise love their jobs. It makes people that hate their jobs stay with their employers long after the thrill is gone. It places an undo stress on small businesses to provide an insurance plan - even when the owner of the business feels like the plan is trash - just to say they have a plan.

I recently heard a statistic that said that basically GM loses money on each vehicle it sells because of the amount of money they spend in employee health benefits.

Why are our employers involved in this at all?

Supposedly there is an advantage to creating large networks of patients to spread the costs and minimize the risks. But all things being equal, most companies are really joining federations of federations. Why not just let individual people join groups on their own. You know, like for homeowner's insurance, auto insurance, renter's insurance... Why is health insurance so different that we approach it in a totally different way?

For that matter, why is you employer the only entity that can aggregate stakeholders? I play frisbee, and belong to the Ultimate Players Association. Why can't they run a health plan? I am a professional theatre artisan and belong to the United States Institute of Theatre Technology. Why not have a plan there? We associate in many many ways that we could utilize for averaging health care costs (some might even say we could aggregate as a nation - perish the thought). Why are we passing this on to employers as a business expense?

Maybe it would make sense if the employer owned a hospital. When I worked at Yale, I was a member of the Yale Health Plan, and I went to a Yale Doctor at a Yale facility. Maybe that makes sense. But really, in situations where the employer is not in the doctor business, why do I want to count on them to make reasonable health decisions for me - especially within the context of their making reasonable business decisions for them (and by transference to me, because on at least some level what's good for the business ought to be good for the employees).

And really, what possible interest should my employer have in mucking around in my off the clock behavior? Do we want employers telling people they can skydive or scuba? How about getting fired for getting a speeding ticket?

This doesn't even begin to touch the idea that employers should do pre-hiring health screenings. Want to lose a chance at a job because your grandparents both had cancer?

This really is a better idea. Lets let employers take that individual premium and turn it into salary, and lets let people work on their own to shop for the best insurance. Let's moot this problem rather than regulating it.