Wellness Controversies Continue

Professor Jill Horwitz has coauthored a very troubling critique of workplace wellness programs, characterizing them as a possible form of cost-shifting to unhealthy workers:

[H]ealth-contingent programs encouraged by the Affordable Care Act rely on the assumption that the returns to health improvement are generally highest for employees with modifiable risk factors, such as an unhealthy diet or a behavior like smoking.

To assess these three assumptions, we reviewed research on the relationships among financial incentives, behavior, health status, and medical spending. We focused on randomized controlled trials involving four conditions—smoking, hypertension, high cholesterol, and obesity—that are typically included in health-contingent programs.

In our review, we found mixed evidence that employees with these conditions have higher health costs than other employees, which undermines the argument that employees with the conditions are particularly effective targets for incentives. We also found little evidence that working-age people change their behavior as a result of financial incentives, particularly over the long term.

These findings suggest that program savings may not, in fact, derive from health improvements. Instead, they may come from making workers with health risks pay more for their health care than workers without health risks do.

Wellness program advocate Ron Goetzel responds: “employers are adopting policy and environmental strategies to support workers in their efforts to lead healthier lives . . . [including] slowing down the elevator to encourage the use of stairs.”  Goetzel believes that “taking advantage of innovations such as moving sidewalks, escalators, automatic doors, and elevators, not to mention dish and clothing washing machines and electric powered windows in cars” helps lead to obesity, and employer wellness programs have a role to play in deterring the occasions of sin (sloth) such machines tantalize us with.

Considering the breadth of freedom modern employment law offers to the boss, such biopolitical soulcraft is only mildly paternalistic.  And if it ends up adding yet more financial burdens to the lives of people caught in a spiral of chronic illness–well, the wellness program advocates appear to say, you’ve got to crack a few eggs to make an efficient omelette.



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