Carrot and Stick Healthcare

                Let’s talk about healthcare reform and “attainment incentives.” There already are some of these attainment incentives in benefit packages today, the most common are employee wellness programs that set standards based on things like Body Mass Index (BMI) and cholesterol levels. The thought being if you keep yourself in good shape, eat right, exercise, do your routine screenings, you will be healthy and therefore deserve a discount on your healthcare premiums, because you will consume less healthcare services, saving money to employers and the overall system. I think the issue I take with all of this goes back to my Dad, who was morbidly obese and tried every diet known to man. He would never be eligible for such rewards, not because he didn’t try, but because he couldn’t achieve the goals and standards. These programs make no distinction between trying v. not trying because they both equate to a “fail” and disqualification from getting the reward. The carrot to develop healthier habits is actually a stick, punishing those who need help the most.

People who advocate these programs say that it places responsibility on the individual where it belongs, much like auto insurance has good driver discounts. I don’t think that is a fair comparison. If only quitting smoking and losing weight were as simple as driving the speed-limit. There are people who think obese people are fat because they are gluttonous pigs who indulge too much and are lazy (and believe me it pained me to write that, but it is true). These provisions follow that thinking, that if you are overweight and/or have bad cholesterol, it’s your own fault, because if you made the effort, you would be healthy. It’s just not so.

Further, people who are all-for-this argue that these wellness plans are “voluntary” and employees do not have to enroll in them. Here’s the issue there, low income people need these incentives to make healthcare more affordable, so they have to enroll, but these are the very people that cannot afford a gym and tend to gravitate towards fast food and unhealthy choices. These incentive plans benefit the wealthy and healthy.

I think there is room in healthcare reform for attainment incentives, but there have to be levels and standards to allow for the lower income people who need assistance in meeting the rising costs of healthcare, and to also allow for the people who need the healthcare services the most.