Tuesday, October 02, 2007

The Slippery Slope

The other morning on the Curtis & Kuby show there was a discussion about new rules and health-related restrictions that were being imposed on employees or would-be employees. Today I found a link to a Chicago Tribune article which concerns this very subject, and may have been the reason for their discussion.

According to the article,

"Indianapolis-based Clarian Health has told its 13,000 employees that, starting in 2009, it will charge them $5 per pay period if they use tobacco or exceed specified levels of cholesterol, blood pressure and other measurements. Penalties could reach $30 per paycheck.

The Cleveland Clinic, on Sept. 1, started nicotine testing in pre-employment physicals. If nicotine is found, applicants will not be hired.

And Weyco Inc., the suburban Lansing [Michigan]-based firm that drew national attention in 2005 when it fired four employees who used tobacco, has expanded the health-insurance requirement, penalizing employees whose spouses smoke or chew tobacco. Penalties are $50 per employee paycheck."

In the past, employers tried the carrot approach to improving employees' health: they would put incentives in place to get the workers to live healthier lifestyles, such as discounts on health club memberships, on-site gyms, or smoking cessation assistance. Now they're bringing in the stick instead.

Weyco, which is a health-benefits administration company, performs random testing for tobacco use every three months. If an employee tests positive for tobacco twice they will be dismissed.

The Clarian policy of charging employees $5 per condition per pay period could be the beginning of a nasty slide down the slippery slope. It's not a big step from charging an employee up to $30 a paycheck for their poor health scores, to actually firing the person. After all, companies are doing it for tobacco use, why not high cholesterol? Where do they draw the line?

I find this kind of information very chilling, especially since I am a cancer survivor and probably would not be top on any list of desirable candidates for a health care provider.

Many of the health conditions being monitored are not necessarily the result of the person's lifestyle habits to begin with: many are genetic in nature. For instance, high blood pressure can occur in people who are in shape and slender. Cholesterol levels are controlled by the liver; often diet does not help.

Rules such as these undermine the very idea of health insurance, which is that risk is spread out over a large group to mitigate the costs incurred by any single person. If those people at higher risk of illnesses are not able to be insured, and can't find employment in more and more companies, what are they supposed to do?

And what about people whose health conditions ARE caused by their own behavior? Will we no longer be allowed to eat at MacDonalds? Will they start searching our cars for Twinkie wrappers? Knocking on our doors at night to see if we're having a cocktail before dinner? How much privacy do we have to give up to our companies or our health insurance providers in order to get basic health care? Why should our personal habits affect our employment unless they impinge on our work performance?

Where do we draw the line and say "enough"?

The last paragraph of the article is a quote by Candace Gorman, a Chicago attorney specializing in labor law:

" 'They will cut as many people for whatever reasons they can get away with. Until Congress steps to the plate and joins the rest of the Western world in mandating universal coverage, the employers and insurance companies will whittle away the coverage, hoping that only the healthy will be covered.' "

I couldn't have said it better myself.


Evil Spock said...

At first, I was like, "good, smokers should be penalized for their own good".

But then I forgot I do have my own vices.

I like carrots instead of sticks, but I like donuts once in awhile the best.

Larry said...

This approach to create the perfect society of perfect workers can not be achieved,and it obviously doesn't take into account factors beyond the employees control.

Big Brother in the healthcare industry.

kuanyin333 said...

Yikes...totally scary! Time to consider becoming an ex-pat!

The Future Was Yesterday said...

There is a certain degree of logic in their thinking, in that health care costs need to be kept down, and obviously, smoking, etc. contributes to those costs.

But the draconian measures you cited, have nothing to do with improving your health, and everything to do with ridding employers of health care costs. Otherwise, you'd see many more programs aimed at helping you stop the negative health behaviors. Our health care program is only for the healthy. Which means they pay nothing out.

Mary Ellen said...

Some of this kind of stuff was going on for a long time. Before I was married, I was working for a big corporation (Union Carbide Corp.) and when I got married I became pregnant right away (good Catholic girl that I am!). Anyway, I was called down to Human Resources and told that if I was pregnant before I was married, that my insurance wouldn't cover the costs of the pregnancy and birth. I was shocked! For one thing, I knew I wasn't pregnant before I got married...good Catholic girl that I was, I didn't have sex with my husband before we were married...I know, sounds archaic. Anyway, I was told if I had the baby before nine months, they would refuse to pay. Not only that, but I HAD to take a maternity leave when I when I was 6 months pregnant, even though I felt fine.

Anyway, the insurance company refused to pay my doctor or hospital until it was determined that the baby was full term at least nine months after the date of my marriage. I had the baby 10 months after I was married.

Even then, the "Christian values" thing was going strong.

Mauigirl said...

Evil Spock - I know what you mean about smoking but of course then there is that slippery slope!

Larry, agree, it's like Big Brother, getting worse every day in every part of our lives.

Kuanyin, even living abroad won't help anyone escape. Even France is starting to crack down on smoking now!

Future, I agree, it's not about people's health (if it were then they'd make sure everyone is covered by insurance). It's about money, as always. Insurance companies are part of funds traded on the stock market. They don't want to have their profits go down.

Mary Ellen, that is amazing. I can't believe they wouldn't have covered the birth of your child if you were pregnant before marriage. If the baby had been premature, then what? That is dreadful. Hopefully that type of thing doesn't happen today. But with those now in charge of our country, you never know. It could come back. And I hate to think what they would've done if you were part of a lesbian couple having a baby! LOL!

Anonymous said...

This is definitely a slippery slope. Like you said, it can easily go from "voluntary" vices like smoking and overeating, to involuntary illnesses. What's to prevent this? Cancer? Kidney disease? You're fired.

Anonymous said...

I'd be all for testing if they started testing people's I.Q.'s.

Christopher said...

This is complicated for me and I'm not sure where I come down on the issue.

First, I am a non-smoker. I detest it. There's also a medical reason for my inability to tolerate cigarette smoke. I have asthma. I developed it as a child and had a tough go of it in high school. Ironically, treatment has gotten much better now that I'm an adult and I live a near-normal life.

Smoking causes so many health problems. Some very serious and even lethal. It is my hope that one day, no one will be addicted to tobacco. I just don't want to see people become ill and die from cancers associated with the habit.

Mauigirl said...

Tom, that's the thing - once they start going down this road, where will they stop? And one of the things that is an issue for me is, that they switch what is considered "healthy" depending on what research showed this week. It's like in Woody Allen's movie, "Sleeper," where he wakes up in another century and finds out that it turns out smoking and french fries are good for you!

After all, until recently it was thought estrogen replacement protected against heart disease, then they found out it doesn't.

Alcohol is bad for you, but it turns out a moderate amount of it is good for you.

Eggs were bad for you, then it turns out that the cholesterol in eggs in moderation doesn't hurt you, but saturated fats do.

Butter was bad for you, so they came up with margarine - then it turns out the hydrogenated fat in margarine is worse for you than butter.

If companies or health insurers start monitoring people's habits based on the medical knowledge current at any given time, it is likely to be wrong!

And then, of course, are the genetic diseases that more and more people will be able to be screened for - and then knocked off the insurance rolls as a result.

Christopher, I share your ambivalence about the smoking issue. I'm an ex-smoker myself (smoked way back in my misspent youth and quit 26 years ago) and I hate being around it. So I'm very glad that smoking is being banned in the workplaces and other public locations. But smoking alone is not the reason for people's health problems. My 88-year-old mother (soon to be 89) has smoked a pack a day for 60 years. She has no heart disease, no high blood pressure, no lung cancer, no emphysema. She doesn't take a single medication. Her sister, my aunt, does not smoke, and she's the one with heart failure and various other maladies.

Everyone knows someone who eats totally unhealthy food and never gains a pound and feels great, and others who are constantly trying to lose weight and can't.

It's all about genes, and if we start getting denied health insurance because of genes, then we're going to be in deep trouble.

The smoking thing is a particularly difficult situation because the government relies on smoking taxes so it remains legal, and yet it is a poison to the system that probably should be outlawed. On the other hand, we have freedom of choice here and as long as the vice of smoking doesn't impinge on others (one's kids, or innocent bystanders) I think we should not be penalizing these people. If they have no health insurance and end up at the emergency room when they get sick, we pay for it anyway. And it costs more that way than having their costs spread out among a large pool of insured people.

Fran said...

Perhaps I should have stayed in Spain...

Honestly, I loathe smoking but as others starting with evil spock have noted, we all have vices.

What next?

This is bad. Very very bad.

TomCat said...

From a different perspective, I can't remember how many times I have tried to quit smoking and failed. I am very considerate about exposing others.

I see this as a way for cdompanies to increase their profit, not genuine concern.

A more viable direction would be to end the vast subsidies the government pays the tobbaco industry and invest those resourses into providing assistance for people who want to quit.

42yrold said...

As with evil spock - i too thought GOOD the smokers shouldn't be doing that. but what about drinkers, casual not just abusive? People with eating disorders, depression, hypertension, Lupus or Rheumatoid Arthritis, and yes, cancer survivors. You are right in asking "when will it stop"... BUSINESSES are trying to protect their money - they are not in it for their workers. Maybe what we can all do is not buy in to corporate america? Make the most of our skills away from the MAN? it's an option.

Mauigirl said...

Fran, I'm glad you did come back from Spain - we need you here or else more of this stuff will happen! ;-)

Good idea, Tomcat; the least the government could do is end the subsidies (it's kind of weird they subsidize the farmers but then tax the cigarettes themselves - they help those who are raising tobacco but penalize those who use it). I sympathize with your efforts to quit - I did it "cold turkey" but did relapse twice before quitting for good. It isn't easy.

Figlet, you're right, it's all about businesses and money. I would like to move out of the corporate world at some point and get into a nonprofit or some other type of job where I feel that I'm helping people. Sadly, though, I can't do that until I am eligible for the retirement healthcare coverage from my Big Corporation! Catch 22!