HEALTH CARE/Joan Retsinas

On Alert: The Health Police

A memo to CEOs distraught over soaring insurance costs: Do you want to shave those costs, without incurring the wrath of employees?

Call in the Health Police, the guardians of today's personal responsibility era. In this era, we all look out for #1. Befitting the mantra of you-are-responsible-for-yourself-and-nobody else, make people who do a poor job of looking out for themselves pay higher premiums.

Smoking, drinking, gorging on fat-laden food, driving without seat belts, frolicking without condoms. All are risk factors for some malady that will cost a fortune to treat. And all are conscious acts: Participants know what they are doing. They know the risks.

Make those risks subject to higher premiums. Start with smoking. The Associated Press (Feb. 17) reports that Meijer Inc., Gannett Co., American Financial Group Inc., PepsiCo Inc. and Northwest Airlines have gone, or are going, this route. Those corporations are adding up to $50 a month to smokers' premiums.

Don't stop with smoking.

Send in the health police to sniff out other unhealthy behaviors. Heavy drinking, for instance, might signal alcoholism, which can lead to cirrhosis, migraines and poor driving (which in turn can lead to accidents). You will do society a favor by identifying heavy drinkers -- and you'll save by making potential inebriates pay up. At office parties, station an undercover informant to take notes.

The police won't need to take notes on eating. Weigh employees to identify the fatties -- and charge accordingly. Maybe a 5% surcharge for every 5 points over the ideal body mass index.

If you have a company parking lot, station a health police officer at the entrance to tag the drivers who don't wear seat belts. Tack a premium-surcharge onto their next paycheck. If anybody drives a motorcycle, double their premiums. Bicycles are trickier. On the one hand, bicyclists are getting aerobic exercise. On the other hand, bicyclists are vulnerable to accidents. Give them a pass.

Profligate, unprotected sex -- the kind that leads not just to venereal diseases, but to unexpected pregnancies -- is trickier to discern. Presumably lots of your employees are having sex, but you need to identify who is having risky sex. The health police will have to snoop -- tapping into the office grapevine, scouring workers' home mailboxes, maybe tapping a few phone and email lines.

Overall, the health police will be costly. Surveillance generally is. But if you net higher premiums from workers, the expense will be worth it.

If anybody objects -- and some malcontent not clued into the era of personal responsibility will make a fuss -- point out that you are encouraging healthy behavior. Re-label the surcharge an incentive. You want the employee to stop the smoking, the drinking, the doughnuts. You want him/her to buckle up, sell the motorcycle and embrace monogamy. This retort will deter criticism. You are not cheap, but compassionate. You want healthier employees.

You know this retort is flawed: If the prospect of heart disease, diabetes, AIDS, disability and cancer doesn't propel people to change their behaviors, the prospect of a premium surcharge won't. You, as well as legions of public researchers, know that. More likely, the result will be that those risk-laden employees will be hard-pressed to pay the surcharge/incentive. And some will drop insurance.

But if enough unhealthy, or potentially unhealthy, employees drop insurance, you come out ahead. Count up the people who opt out. Even some of your executives might be too risk-laden to afford the surcharges. If a sizeable chunk of your workforce drops out, you end up with a healthier insurance pool. That's another reason to call in the health police.

With luck, you may end up able to drop insurance entirely.

Consider the president's proposed gift to American business: health savings accounts. These accounts would let employees buy catastrophic policies, setting aside tax-free dollars to pay for non-catastrophic expenses. Only healthy, wealthy employees would take this tack. Lured by the tax benefits of a health savings account, some of your healthy, wealthy employees will also opt out.

If enough employees -- healthy and non-healthy -- opt out, your pool will have shrunk to the point where you can drop insurance.

Once you drop insurance, you can disband the health police.

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

From The Progressive Populist, April 1, 2006

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