Health Care: Tales of Pipers and Tunes

Business Week writes of the frontiers of employer intervention in employee health–all in the name of cutting the costs of employers helping pay for employees' insurance. One Scotts Miracle-Gro lawn technician, Scott Rodrigues, is fired for smoking on his own time, and he's suing, with his case now before a federal court in Massachusetts. Some excerpts from a very long story:

How do executives looking to cut medical costs persuade employees to take better care of themselves without killing morale and spawning lawsuits? It's a question that's very much on the mind of Scotts CEO Jim Hagedorn, who acknowledges his company's wellness program is controversial. "Jack Welch told me: Man, you have balls of steel,'" says Hagedorn. "This is an area where CEOs are afraid to go. A lot of people are watching to see how badly we get sued."

……. "We have this notion that you can gorge on hot dogs, be in a pie-eating contest, and drink every day, and society will take care of you," says Harvard Business School Professor Michael E. Porter, who co-authored Redefining Health Care. "We can't afford to let individuals drive up costs because they're not willing to address their health problems."

Hence the wellness fixation at companies as varied as IBM, Microsoft, Harrah's Entertainment, and Scotts. Employees who voluntarily sign up for such programs often receive discounts on health-care premiums, free weight-loss and smoking-cessation programs, gratis gym memberships, counseling for emotional problems, and prizes like vacations or points that can be redeemed for gift cards.

Companies save money. Employees get healthier. What's not to like? But the wellness craze raises important issues. One is that people could start blaming unhealthy colleagues for helping push up premiums. Then there are the privacy and discrimination issues: How far should managers intrude into employees' lives? That's the essence of the Rodrigues lawsuit.

This story from the December Governing points to another way out of the dilemmas and control issues that arise from having other people on the hook for your health care–the attitude of control inherent in the above comment from Harvard's Porter, where "we" start to decide how "you" can live because of the health care payment system. How about more actual consumer control, and consumer payment, for simple health care needs, as in the growing trend of medical clinics run by "nurse practitioners"—complete with prices listed on the wall, a real luxury when dealing with health care providers–in some of America's favorite superstores such as Wal-Mart, Target, and CVS?

Of course, the dark cloud of professional guild jealousy and regulatory control is already shadowing this so far quite popular, and quite profitable, system of simple health care delivery:

For state and local officials, the clinics raise the usual concerns about quality of care and possible need for regulation. At this early point in the trend, retailers' reputations are on the line and care is based on carefully standardized procedures. Nurse practitioners follow evidence-based-medicine protocols and guidelines set down by state medical boards. Moreover, the medical problems for which they provide care are limited to minor ailments……"They have high standards now," says Rick Kellerman, a physician in Wichita, Kansas, who is president of the American Academy of Family Physicians. "But as they proliferate, they could overreach on what they treat and who treats it."

Alas, we shall always have with us people like Dr. Kellerman to try to make sure no one "overreaches" on selling Americans services they want at prices they choose when it comes to the holy physicians turf.