HEALTH CARE/Joan Retsinas

Health Policy, by Monty Python

At the fanciest hotels the bellmen whisk your suitcases onto luggage carts and deliver them to your room, putting them on your bed. Instead of those clunky luggage carts, how much more graceful if they carried the bags on their heads? Maybe the bellmen could pirouette as they opened the door, demonstrating perfect balance. And why not have bellmen whisk you away at the same time, carrying you to your room? A romantic start to a vacation.

Retail malls occupy shoppers for hours at a time. Every customer has chafed at long lines circling the check-out counters; some customers have abandoned their merchandise, vowing never to return. Why not have retail clerks do acrobatic stunts every hour? Or dance? It would keep those bored shoppers from leaving.

Restaurants can be just as boring -- not much to do as you wait for somebody to bring your food. How about making waitstaff roller-skate, double-axeling the food to your table? It would be a bigger draw than free appetizers.

Incorporating physical feats into your workers' routines would not only enhance your business, it would lower your healthcare costs too. Wal-Mart has shown American business the way out of health care debt ("Wal-Mart Memo Suggests Ways to Cut Employee Benefit Costs," by Steven Greenhouse and Michael Barbaro, New York Times, Oct. 26, 2005). Their answer is simple yet brilliant: Hire healthy employees, who won't run up medical bills.

That answer, though, is no secret. Everybody knows it. The problem is how to do it.

An employer can't ask for detailed medical charts as part of the job application, then dismiss the sickly applicants. Medical records are private. Besides, the Americans with Disabilities Act has nixed any strategy that weeds out people with disabilities, or with chronic illnesses. A company can reject a drug-user -- but not a medical-user. Lots of applicants give clues to being "medical-users": They wheeze, wear a disease-identification bracelet, are over age 60 or are obese. The clues are not hidden. But the company that acts on these clues risks litigation.

Wal-Mart has proposed an end-run around the Americans with Disabilities Act: Incorporate physical tasks into the job-description. These refashioned, re- invigorated jobs will favor able-bodied, healthy applicants.

Consider the possibilities. The Wal-Mart memo recommended that cashiers gather carts -- a challenge given the store's mega-parking lots, and an ordeal in winter sleet. But lots of other jobs throughout the economy can be refashioned. Hotel bellmen, for instance, need to do moderate lifting, press elevator buttons and be courteous. Add heavy lifting to the task, and you shrink the applicant pool to the robust. Retail staff must stand for hours; that predisposes against older, arthritic or obese applicants. Make salespeople do acrobatic stunts, and you ensure that you hire the fittest of the fit. Making waitstaff roller-skate guarantees you a pool of young workers.

Right now efficiency has determined the design of the workplace. Data entry workstations are near printers; nursing stations are close by pharmacy stations; elevators are everywhere. Redesigning the workplace to make people walk, climb, even jog will weed out the frail. Of course, this strategy is not perfect.

If one of the fittest of the fit employees develops a disability, the law requires the company to make accommodations -- so there may be a few bellmen who use luggage carts, or waiters who don't skate. And over time the fittest of the fit may develop some frailty. Statistics show that as people age, they use more medical care. The "low-user" a firm hires one year may be a "moderate-user" after ten years.

Yet this new notion -- designing physically fit job descriptions to lure physically fit workers -- may buoy American businesses drowning in healthcare debt.

This notion was brought to you, not by Monty Python, but by Wal-Mart.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, Dec. 15, 2005

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