Monday, March 7, 2011

True Wellness Balances Left and Right

Health care in America is an intensely personal and private matter that has enormous public implications.  As much as we would like to compartmentalize our personal health decisions away from the public impact of those decisions, we cannot.  If we contract the flu and do not seek treatment, we are more likely to infect others.  If we do not participate in a health insurance program and become injured in a car accident, the costs of emergency care are shared by all.  As a national ethos, we value independence and self-reliance; as a society (and humanity as a whole), we are interdependent and affected by the decisions and actions of our neighbors.  It may not always be obvious in the moment, but it is nonetheless true.  Somewhere in the middle of these competing values lie privacy rights, and therein is a philosophical battleground.

With this in mind, I am drawn to a current debate regarding wellness programs.  Wellness programs have gained popularity with employers as a way to encourage positive private health decisions that promote positive outcomes for the entire group.  Most wellness programs allow individuals to voluntarily participate to improve their own health, while the employee’s participation has the added benefit of keeping down potential health care costs for the entire population.  Productivity of workers has been shown to increase in work environments that promote personal wellness.  These programs include among other things weight loss contests, health risk screenings, and exercise classes.  This sounds like a perfect solution that has both an individual and group benefit.  Things get slightly more complicated when we start talking about effective metrics for these programs, and the potential for privacy breaches.

Here’s an example of what is being debated right now.  According to some interest groups, regulatory barriers exist that discourage employers from offering wellness programs.  The main barrier seems to be the rules protecting personal private health information.  Health care advocates and employers need this data to measure results and encourage behaviors that benefits everyone in the select group.   Some labor advocates have accused employers of sponsoring wellness programs to penalize or remove employees from their health plans, and some regulators agree. 
Another example is the collection of family medical history information from employees during employer sponsored wellness screenings.  Medical professionals will tell you that without information on someone’s family medical history and the person’s predisposition for certain conditions, it is more difficult to draw up a proper wellness regimen that fits the individual.  Without family history, you are left with a generic one-size-fits-all approach, hardly the best advice for custom situations.  The GINA law (Genetic Information Nondisclosure Act) bars employers from offering any incentive to employees to divulge this family history.  Is this classic overregulation, or reasonable privacy protection?

Gretchen Young, senior vice president for health policy at The ERISA Industry Committee (ERIC), a not-for-profit representing large U.S. employers, recently spoke to regulators at a meeting held by the U.S. Department of Health and Human Services:

Even if plans do not give their participants a financial incentive to complete a risk assessment, they are still unable to use any family medical history obtained from the risk assessment to guide these individuals into disease management programs, Young explained, noting that “experience has shown that without the encouragement of a health professional, many participants who would benefit from participation in a disease management program will never enroll.”

Source article: 

Employers, it can be argued, are trying to help their workforce with wellness programs tailored to individuals.  Regulators, it can be argued, are suspicious of employer’s motives for wanting to be so benevolent, and have a critical role protecting workers.  Can both sides be right?

Unfortunately, even something as universally accepted as personal wellness and overall health awareness has its challenges, and Right and Left have conflicting, and in my opinion, legitimate views on the subject.  This issue isn’t even viewed uniformly within the same political persuasions.

Some on the right would question the corporate intrusion into personal health choices, another example of the ‘nanny state’; others on the Right might reflexively see these regulatory barriers as another government expense driving up health costs, and therefore support elimination of these regulations.

Some on the left will argue that this invasion of privacy will be used to discriminate against high risk individuals in employment decisions (and it is an invasion if those who comply with the medical history requests receive financial benefits that others who are more guarded with their history do not); others on the Left will say that wellness programs like this are the best way to promote a stronger workforce, and these programs represent an employee-employer relationship model worth expanding.

Clearly, it will take some unlikely alliances to move wellness programs into the 21st century.  The answer to this issue may not fit neatly onto a campaign bumper sticker, and each side’s proponents cannot easily be given political labels.  Real life, as it turns out, is much more complicated.

Editor’s Note:  A full posting on wellness, and I haven’t even mentioned the silly attacks on Michelle Obama’s promotion of healthy eating habits.  Who knew telling you to ‘eat your vegetables’ like your mama told you was the 3rd rail of politics.  Bon appetite, and be well! 

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