Welcome to Health-Man! Abs of kryptonite. Pecs of steel. Able to out-run the fastest treadmill, out-row the toughest Nautilus. Toast for breakfast, tofu for lunch, vegetables for dinner — Health-Man eats it all.
This superhero has descended on America to save our extravagantly high-spending health system. Health-Man will inspire us to give up doughnuts for granola (low-fat), to forego television for a Nautilus, to run a half-marathon whenever daily stresses weigh heavy. As we emulate Health-Man, we too-flaccid, too-sedentary Americans will make fewer visits to physicians, have fewer stays in hospitals, undergo fewer MRIs. Health-Man will not only trim our waistlines, but our national health care tab. What a hero!
Employers are putting their faith in Health-Man. Employers have long nudged employees to get healthy, often with gym memberships.
Those voluntary nudges are now passé. Employers have discovered penalties. Why not penalize people who are overweight? Sedentary? Non-compliant with their medical regimens? (Health risks can cost workers, Sept. 9, 2007, Associated Press). Clarian Health, for instance, in 2009 will dock the paychecks of obese employees by $10. For employees with high cholesterol, blood pressure, or blood glucose levels, Clarion will dock checks $5. Western & Southern Financial Group raises insurance costs from $15 to $75 per month based on body-mass-index scores. (Initially, 40% of employees paid the higher rates.) HMO UnitedHealthcare will lower employees’ deductible for every goal (blood pressure, cholesterol, weight, smoking) they meet. (“Privacy is true price of health worker discounts,” Arthur Caplan, MSNBC.com, Aug. 15, 2007)
At first, this seems reasonable. After all, employers pay to treat diseases related to obesity, sedentary lifestyles, and neglect of prudent self-care. The epidemic of diabetes is not linked to a bacterium, but to over-eating and under-exercising. High blood pressure is treatable; the person who refuses medication risks a stroke. Vaccinations have almost eradicated tetanus, diphtheria, whooping cough, polio. Health-Man can whip us all into a healthier shape.
Yet a deus ex machina — even heroic Health-Man — will not save the day, budget-wise.
Think of the maladies that healthful living will not keep at bay: multiple sclerosis, Parkinson’s, cancer, tuberculosis, schizophrenia, glaucoma, arthritis. Healthy thin people get them.
Think too of the relationship between health living and health: the former does not guarantee the latter. I know sedentary people who have body/mass indices that I ache for. I know gluttons who are runners, and runners with high cholesterol. While obesity predisposes people to Type 2 diabetes, some thin athletes develop the disease. Sanctions risk penalizing people for their combination of genes and bad luck.
Sanctions also risk penalizing people for their disabilities. Ironically, with The Americans with Disabilities Act, Congress encouraged employers to hire people with disabilities. Employers must try to make accommodations. The impetus was not to save employers money: accommodations will cost money. The impetus was to bring people with disabilities into the larger community, to help them enter the workforce (as well as enter public buildings, restaurants, transportation). The enthusiasm for Health-Man encourages employers to avoid anyone with a disability.
As for the employees an employer cannot avoid – the ones who cannot easily lower their weight, their cholesterol, or their blood pressure, the system of sanctions must acknowledge those restrictions. The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires employers to allow “reasonable alternatives” for people who cannot exercise, who are held to special diets, who are struggling to maintain a status quo.
Finally, Health-Man threatens to lay waste not just to our gluttonous habits, but to the nation’s core respect for employees’ privacy. Thanks to the civil rights movement, employers are supposed to evaluate employees through lenses blind to color, ethnicity, and gender. The employer is supposed to ask only: Can this person do the job? How well? The zeal to make us healthy invites employers to grab Health-lenses: what is our body/mass index? Our smoking history? Our sexually transmitted diseases?
In this political time when many Americans see government either as superfluous or inept, Health-Man is a tempting hero, resonating self-reliance. But Health-man is not strong enough to fix our health care system. He needs an Uncle (Sam).
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.
From The Progressive Populist, March 1, 2008
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