Raising workers’ health insurance payments for bad lifestyle habits

One of the unfortunate by-products of our messed up health care system is how some employers are raising employee health insurance contributions for those who engage in lifestyles deemed unhealthy.

They may smoke. They may eat too much or the wrong foods. They may not participate in preventive care. As Reed Abelson reported for the New York Times last November:

More and more employers are demanding that workers who smoke, are overweight or have high cholesterol shoulder a greater share of their health care costs, a shift toward penalizing employees with unhealthy lifestyles rather than rewarding good habits.

This isn’t a screed against personal responsibility. And I understand why employers are assessing options to lasso out-of-control health insurance costs.

But what I see here is a scary slippery slope, one that leads to certain individuals bearing a heavier burden of their health care costs based on the supposed riskiness of everyday conduct.

It may sound good until you apply it evenhandedly: The person who has no problem imposing higher premiums on smokers may forget that the steaks and burgers he enjoys provide reason for raising his premiums, too. And what if vegetarian who doesn’t mind sticking it the carnivore is not getting recommended amounts of protein in her diet? Does this mean that she should pony up higher payments as well?

In addition, if we’re going to play this game, what responsibility do companies that market some of these products bear for promoting these habits — the cigarette makers, fast-food restaurants, and beer companies? They know darn well that their products will have some negative health effects.

And what about bad employers that create stressful working conditions that, in turn, cause some workers to engage in less-than-healthy habits? If we’re preaching responsibility here, shouldn’t they pay a higher share of our health care costs?

Health insurance coverage helps to protect us against the costs of being human, including our own foibles and weaknesses. America remains one of the world’s wealthiest nations, and we have the capacity to provide affordable, quality health care for all. This type of business practice, however, is takes us in the opposite, more punitive, direction.

15 responses

  1. Forgive me if this is too obvious, but poverty is a leading social determinant of health. No health benefits for the poor…because a)they have poor health AND because b) they can’t afford premiums!?!?

    Wow. Kicking down the down and out. In case they aren’t down or out enough. Or (and I am not joking here)… lift people out of poverty and their health and productivity rises. What a concept!

  2. I understand that illness is a big cost for health insurance, but what about injuries? Many of these “healthy” people get seriously injured doing their “healthy” activities. I wonder if analysis has been done on how much the average employer pays in joint surgery and physical therapy. Should we penalize those who go skiing more than average?

    • I seem to recall that some insurance companies at one time were trying to limit benefits if you engaged in “dangerous ” sports. Does anyone remember that? I remember having conversations with colleagues about who gets to define “dangerous”.

  3. Not only is this a slippery slope, it does not take into account the reasons why many have unhealthy habits. Often those who are overweight or have addictions have come from families who have abuse issues. The health system discriminates against people who need mental health treatments.

  4. A few years ago I worked at a small company where about half of the employees smoke. I can’t say I was thrilled to be subsidizing the smokers’ health insurance, but I was hoping they would respond by initiating a smoking cessation program, not by penalizing the smokers. In fact I sent the owner information on how workplace smoking cessation programs pay for themselves, but he wasn’t interested.

  5. I think you hit it right on the money David. I remember in 1994 when health insurance rates first started to creep up, if i remember that year the premiums doubled for family coverage and individual was still free. I do not believe this has anything to do with the behavior of people and what they eat or smoke or how much exercise they get. Peoples behavior has not changed since insurance rates have risen. This is another excuse for employers to keep the money in their own pocket! I am not sure what the real reason for the massive increase has been, partly, greedy insurance executives and their 2 million dollar a year bonuses would be one.
    What i would say is fair is that if employers did their part to create a healthy work environment, the cost of healtcare would decrease significantly. In my latest research America spends some 400 billion dollars a year on work related stress, how much is directly related to bullying i am not sure, but some for sure. People are abused at work they get depressed, and anxious, then they get on medications, then they require therapy, we all know how much a psychologist charges now $175.00 an hour multiply that alone by the number of people stressed at work and are seeing a counselor x how many in the U.S. and that number alone would be staggering and that does not include medications which probably average $200.00 a month per person that are taking them. This piece alone would cut healthcare costs dramatically. So i would say to employers when they are ready to step up to the plate and create a safe and healthy work environment, then they can run their mouth about what the employee is not doing right!!!!!

  6. Yes, if we are going to slide down this slope, then make the employer responsible for creating the stressful work environment.

    Personally, I would like to see health insurance separated from employment. Employers already have too much power over workers. Lots of us put up with lots of abuse at work because we needed the health insurance for ourselves or for sick family members.

    People should be able to purchase insurance, at group rates, for their families. Then, when people lose a job, they don’t lose health insurance along with it. Then, employers would not have any right to ask employees about their personal habits on health questionnaires.

    It would be better if health insurers had more competition, just like the automobile insurance industry does (ever hear a GEICO ad?). Then, health insurers might not be earning billions while sick people have to resubmit claims 3-4 times to get coverage.

    If individuals could purchase health insurance at group rates, then employers wanting to attract top talent could boost salaries and let people buy their own benefits. Employees would be less dependent on employers for salary AND health insurance and it would be a step forward in rebalancing the power dynamic between employer and employee.

    I have to wonder why we have the system we have. From the insurer’s point of view it works – they manage big accounts and avoid having to market to the masses. From the employer’s point of view it works – it gives them an advantage in attracting employees and then gives them leverage in exerting control over them.

    The current system does not work so well from the individual’s perspective. In my case, for example, it was well-known that I was caring for a seriously ill family member. My former supervisor repeatedly used that as leverage to threaten me.

    • Excellent point! It does give the employer another way to exert power over the employee and balance is the key word. America needs to get back to letting the employee do what they are hired to do and compensate them appropriately for the job for what it is worth in job market. Leave polotics out of it and allow workers to provide for themselves and their families. The major source of trade in this country is money and we ought to be able to work, earn a fair wage and be left alone. All of us that have been severely bullied know all too well the games and polotics that cut into our work and destroy good careers and health. It is not necesary and is unproductive, the sooner employers realize this and lawmakers do something about it, we will all be better off. It is all about money and power, what a shame!!!!!!!!!!!!!!!!!!

  7. Mel, I think workplace bullying is the #1 cause of illness for workers. I believe that only by making the cultural change necessary to eliminate that kind of behavior will these illnesses be reduced. Having the insurance separated from employment is a great idea. Germany does that and the insurance is chosen by individuals for life. Alternatively a national health insurance program also makes sense. The industry now is allowed 20% overhead. That amount is way too high. Government programs like Social Security work on less than 3% administrative costs.

    The insurance companies are adding to the cost of providing care by running most procedures through third party screeners who try to delay and deny care. What that does is force patients to expend more dollars doing senseless things before effective treatment can be provided. An example of that is forcing physical therapy for muskoskeletal problems before any MRI or CT scans are done to accurately diagnose the patient’s problems. This is ineffective and costly but counts as treatment dollars under the law.

    • It is not only bullying that makes people sick. It is the defacto 60+ hour work week, little to no vacation or sick time and for many people doing the job it once took two to do; all the while looking over your shoulder, wondering if you will be the next to be laid off. From personal experience, I had lower back pain that was unrelenting and making my doctors rich –then I took early retirement. My back, though not perfect (I do have “moderately severe” spinal osteoarthritis), has never been better. Other than being a little stiff in the mroning — I am pain free and gardening and working around the barn. And all it took was getting out of the rat race.

  8. Of course, an employer should charge extra to the employee who makes “poor health choices”, be they workaholism, skydiving, marathoning, hunting, sex tourism, and so on. Why not a surcharge for indulging in alcohol, nicotine, illegal drugs, sex tourism, emotional abuse of others, irresponsible use and discharge of toxic chemicals, overuse (or underuse) of food, and so on. It’s common sense. And really, how hard can it be to track?

    To be fair, employers should bear their own extra costs for fostering workplace practices that are known to damage staff’s health. If the work’s too stressful — sedentary, say, or characterized by unrelenting noise, little break time or job security, excessively long workdays, inadequate safety measures, poorly designed-and-maintained equipment — that environment should cost them. Why not apply a multiplier effect for employers which chisel staff in every possible way? Shouldn’t we assess multiple fees for multiple infractions and types, plus a penalty zinger?

    While we’re at it, let’s drop the spurious “distinction” between physical and emotional health. Emotions are electrochemical impulses traversing, triggering and reconfiguring neural tissues. In other words, emotional illness is a physical illness. That, of course, is why negative emotions clobber the endocrine system, raising stress hormones across all systems of the body, impairing sleep, etc.

    While we’re on the subject of holding workers and employers accountable for their health-related habits: why not levy a surcharge for every externally-owned, residential-rental property that permits on-site smoking? The workday is but a slice of one’s life experience; an even-larger share occurs at home. OSHA’s done wonders for the workforce, but renters in every state have zero protection from a neighbor’s smoke, unless all inhabitants are owner-residents and vote to prohibit smoking. I suppose we might also charge single-family and multi-family-homeowners who allow smoking, too. All this would partially offset the societal health costs of exposure to Class A carcinogens: lifetime damage to each child’s vascular development, and, for entire residential populations, an increased risk of heart attack, stroke, cancer, emphysema, premature birth and death, etc.

    Liberty at work, liberty at home, and long live free enterprise — which I hope one day to see.

  9. I didn’t expect that this little item would garner so many comments, but I’m glad it did. This is another sign of how a system geared to benefit a few is sticking it to the many…in this case by demonizing targeted groups.

  10. Oh, David, have you stepped in a steep pile! 🙂

    I’m a big fan of the HAES (health at any size) approach to eating, weight and connected issues precisely because it asks a lot of these kinds of questions to challenge the prevailing wisdom (which we know ain’t always all that wise). The critical thinking it encourages is certainly applicable to other health questions, too.

    Good example: let’s say someone’s overweight. They’re going to have to pay higher health insurance costs. WHY are they “overweight:”? Do they have injuries limiting their ability to exercise? Live in a “food desert” with limited access to fresh produce and high quality, less-processed food at affordable prices? Are they taking one or more of the bazillion medications that mess with their weight? (I have personal experience with this one, having experienced a delightful 30-pound fluctuation all based on whatever medications I was trying for a chronic health problem.) Are they working two jobs to make ends meet, so they have no time to do anything but grab take-out? The possibilities go on and on, despite what the diet industry would sell you. That’s just ONE health question.

    I agree with everyone here–this is a slippery slope we DON’T want to slide down.

    • This is more than a slippery slope!! In fact it is plain b.s. employers are being robbed by insurance companies and they are desperate to keep good workers that they can provide health coverage for. Nothing has changed in how employees take care of their health in 4o years, this is simply a way for employers to try and save money. The first step as i said before is to reduce stress in the workplace, create an environment that is conducive to learning, growth and a future and you will see medical bills drop. Many people are working overtime without pay, there being bullied, they are doing the job of 3 people and they are mistreated in unimaginable ways. Employers need to start right there and rconstruct the working environments so people want to go to, work not run away from it and run to the psychiatrist. This has gone on way too long and we will not likely see a drop in healthcare expense for employers until it does. Estimated $500 billion a year is spent in the U.S. on work related stress, you do the math!!!!!!!!!!!!!!!!!!!!!!!

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