Summary: The issue of insurers incentivizing good behavior, and particularly the relationship of such policies with the growing epidemic of obesity, calls integrative practitioners to the challenging balancing act of finances, health, behavior change and of compassion. Here, Integrator reader Charlie Priester, a self-employed, informed consumer of integrative, natural health practices – particularly of the self-care variety, wades into the debate. He offers ideas about how such policies can be good for naturopaths, acupuncturists and Yoga therapists, and for self-employed individuals like himself. Priester is a former colleague in publishing the hard-copy Integrator (1998-2002) and in developing the Integrative Medicine Industry Leadership Summits (2000, 2001, 2002).
The Integrator has repeatedly returned to the theme of incentivizing behavior because many hard issues must be held in balance (compassion, personal responsibility, economics, individuality, public health) and because Integrator columnist Michael Levin has repeatedly focused on the subject.
Here the writer, Integrator reader Charlie Priester, responds to Levin, to new research as reported in the New York Times and to recent Congressional perspectives from the perspective of a self-insured consumer and user of integrative services who has been close to the integrative practice field for a decade. Priester is a former colleague in publishing the hard-copy Integrator (1998-2002), the Industry Health News Files and the Collaboration for Healthcare Renewal News Files and in developing the Integrative Medicine Industry Leadership Summits (2000, 2001, 2002).
Government Should Demand Insurers Offer Incentives
for Healthy Behaviors
“After I read the latest issue of the Integrator Blog, specifically the column from Michael Levin entitled “Financial Incentives for Wellness: Good for Integrative Practice?” I
was uncharacteristically moved to send a comment.
“My first reaction was to target weight loss: ‘Even though Senator
Ensign is a little like having the Wicked Witch of the West as a co-sponsor,
you know I’ve been arguing for years that there ought to be some kind of
financial incentive for wellness. No easy way to do it, I agree, but obesity
and even just “overweightness” is clearly out of control in this country, and
there’s plenty of evidence regarding the probability of a whole host of health
issues based on it….’
Are these incentive programs
‘good for integrative practice?’
Well, they sure ought to
“The following day, an article in the New York Times appeared,
citing a report by Kenneth Thorpe, which projects that if current trends
continue, 43% of American adults will be considered obese by 2018. The number
as of 2008 is 31%, which is scary enough, and that’s just adults!
“After doing a little more research, I came to realize that my
first reaction basically lands in the ‘Safeway Amendment’ camp. Safeway CEO
Stephen Burd offers his employees a break on their premiums if they meet
certain criteria re: smoking cessation, weight, cholesterol and blood pressure.
If they succeed at all of them, they can save as much as $800 per year on their
share of premiums. In a Wall Street
Journal editorial, Burd wrote that ‘if the nation had adopted our approach
in 2005, the nation’s direct healthcare bill would be $550 billion less than it
“Essentially, this ‘outcomes’ argument is that employers (and
perhaps the government) should adopt the auto insurance model, which rewards or
penalizes certain behaviors. No employee has to lose weight or quit smoking
(this is America, after all), but there’s a financial incentive to do so.
“Every article I read adds to the complexity of the issue, but I
keep coming back to the certain belief that no matter what Congress does
regarding health insurance reform, if U.S. citizens don’t start to exercise
more and change their diets to include more fresh, real food, healthcare costs
will continue to spiral out of control.
the government is really interested
in taking on the bigger public health
crisis we face, and if they are in the
end going to mandate that everyone
insurance, I say they ought to
demand that health insurance companies
themselves offer financial incentives to
encourage healthier lifestyle choices.
“’Good for Integrative Practice?’ you ask. Well, it sure ought to
be, if for example, naturopaths could take all their expertise in the realm of
nutrition and develop some ‘certified’ educational programs that employers
could offer to employees. Or if acupuncturists could make the case that their
treatments will help an individual achieve the outcomes that a Safeway demands.
Or if yoga instructors harnessed the popularity of their discipline and
persuaded employers that their classes should be considered as worthy of
subsidy as gym memberships.
“For the self-employed and self-insured like myself, I wish
insurance companies would offer discounts to people who eat well, exercise
regularly, and meet whatever ‘Safeway’-like criteria they want to set up. If
the government is really interested in taking on the bigger public health
crisis we face, and if they are in the end going to mandate that everyone buy
insurance, I say they ought to demand that health insurance companies
themselves offer financial incentives to encourage healthier lifestyle choices.
“Of course, as long as we’re at the mercy of our current for-profit
health insurance industry, and so long as that industry makes money off
self-motivated folks who pay premiums and rarely have claims, this is probably
not going to happen.”
Comment: Priester’s commented that whatever the government does, U.S. citizens need to change their habits. This brought to mind Recommendation #7 from Andrew Weil, MD on his Call to Action on health reform. After ticking off 6 powerful public health and top-down government-backed initiatives (which will need a bottom up citizens campaign to be passed), Weil expresses #7 simply: “Learn how to take care of yourself!”
Did anyone notice that the
Safeway amendment is not
called the Blue Cross-Blue
Priester is right:
More of the sobering information from the report on obesity by Thorpe, as cited by Priester, is worth re-stating as we ask ourselves whether we need additional hard-hitting tools for addressing the rise of obesity and its impacts. Here, from the New York Times account:
“Mr. Thorpe concluded that the prevalence of obesity is growing
faster than that of any other public health condition in the country’s
history. Health care costs related to obesity — which is associated
with conditions like hypertension and diabetes — would total $344
billion in 2018, or more than one in five dollars spent on health care,
if the trends continue. If the obesity rate were held to its current
level, the country would save nearly $200 billion a year by 2018,
according to the study.”
The relevant questions here are, if the whole country were on the Safeway plan, what would the savings be? What would the loss be?
As one who was until recently on a self-employed insurance plan, I am fully aligned with Priester’s recommendation that insurers offer incentives for healthy behaviors. Unfortunately, I am also aligned with his view that insurers are not likely to offer such incentives as long as it doesn’t make sense to their bottom line. Safeway, as an employer and payer of benefits, is incentivized to keep its costs down and be inventive. But insurers, which are essentially cost-plus operations (they are allowed to keep a given percentage of premiums for overhead and profit, and the percentage stays pretty much the same as the base increases) has its bread buttered by the rise in costs. 28% of $100 is less than 28% of $200. Did anyone notice that the Safeway amendment is not called the Blue Cross-Blue Shield amendment?
Yes, we need what Priester requests: a government mandate.
for inclusion in a future Your Comments Forum.