Thursday, June 10, 2010

Why Incentive and Penalty Programs to Encourage Health are a Bad Idea

Over at Budgets are Sexy, J. Money brought up the subject of Employer and/or health insurance incentive/penalty programs. It really got me fired up! My comment got so long, I decided to bring the discussion over here.

The problem comes up with who decides what’s healthy and how to incentivize “healthy” behaviors. When you bring up something like smoking, it’s seems easy and kind of clear cut. Smoking is indeed 100% a choice. It’s good to not smoke. However, something like obesity is much more nuanced. How are we going to police that and do we really want to?

Being overweight is not a behavior, it’s a descriptor or you could say, a symptom. Same with high blood pressure, etc. Things like the kind of food you eat and exercise you do are behaviors. As an aside, we all know thin people who can eat “whatever” they want and never seem to gain weight (maybe like my friend J. Money?) We also know fat people who have dieted their whole lives who nonetheless, remain fat (me). Somehow, the former “makes sense” and we can assimilate that info but the latter somehow means that the person must be lying about their habits or “not trying hard enough”. And on the flipside, what about all the people training for marathons well into middle age and “draining” the health system with all their joint replacements and doctors visits? Somehow, pushing your body to the max is OK and dealing with all the injuries is a small price to pay for so-called “good” health. Not to really knock marathoners – I’ve completed 2 myself – shocking for a fat girl, but true. Was I being irresponsible to risk such an endeavor at my weight? Did anyone suggest that I might be a burden on the medical system? No, I got congratulated for my efforts. I’m making a point that it’s all about CHOICE – and who gets to decide which ones are good and bad. We do not want third parties deciding this stuff for us because in the end, it’s more about moral judgments than budgets and certainly more than actual real concern about health.

In any case, if we can agree that determining health can’t be as simple as looking at someone’s weight or BMI (which I hope we can!) do you really want to be turning in food diaries and tally sheets of your exercise to your employer or insurance company? As an individual, do you really want to give over that much info and control so that you can get a fair price for medical coverage? Should we really be penalizing those that need the most help? An example of a corporate wellness program I’m aware of is one rolled out by Whole Foods where they give an extra discount to employees who meet certain criteria (BMI, blood pressure, and cholesterol must be in the “normal” range) and are willing to share it with the company. Sounds great, right? But when you think about it, why wouldn’t you want to impede access to healthy food to the employees who are overweight, etc? Aren’t they the ones who (supposedly) need it the most? Who’s to say they won’t use that info to quietly weed out these “undesirable” employees?

As always, the devil’s in the details and I don’t think anything good can come from these types of programs when they’re tied to incentives or penalties. How about our private lives remain our private lives? How about we funnel public resources into making sure every family in America has food to eat? Grocery stores nearby that carry fresh produce? Bike paths and parks to encourage exercise for fun and socializing (moving your body isn't a punishment, it's fun, remember)? Money to fund quality school lunches, physical education, and ball parks for ALL students? How about we take worrying about “obesity” out of it? Don’t we all deserve to have access to healthy food and activities? Isn’t it good for EVERY body? We do not need to stigmatize people to get us (as a whole) to collectively do a better job of providing healthy options.

From a personal perspective, I work for an organization that offers an array of healthy workforce initiatives – yoga, pilates, and Zumba classes, seated upper body massages, and two fitness facilities – all onsite at reduced cost (the gyms are free). I don’t have to prove to anyone that I’m making progress or give them ANY personal info to take advantage of these things. Do they make me enjoy working where I do? Do they add to my quality of life? You bet. Do I feel pressured to use them under threat of losing privileges? Nope. I think it’s a fallacy and insulting to suggest that people just don’t know what’s good for them and we need to give out gold stars and detentions to get it into their heads. Taking good care of yourself takes time and it takes money. Providing that as a society to people will do far more to improve our overall health as opposed to creating invasive programs to police our personal lives.

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