Employers As Healthcare Gatekeepers?
Eat your vegetables. Turn off the TV. Go outside and play. Go to bed on time.
These four imperatives were once amongst the core messages delivered to children by their parents and neighbors, a setting of behavioral parameters that people intuitively expected would help to produce healthy, well-balanced kids.
We’re not so good at this anymore. Like so many other behaviors that animate the phrase “personal responsibility,” in the face of economic and demographic tumult we have decided to pass the buck on them in our homes, neighborhoods, schools, and churches. We now want employers to handle them, and health-contingent wellness is the final step in the ascendancy of the employer as the new parent.
Employers find themselves teaching employees how to read and write effectively, do math, be polite, how to eat in the presence of others, and even how to sleep better. Why not throw at their feet the notion that employers should coerce workers into intrusive and dubious health-contingent workplace wellness strategies that are easy as pie for the healthiest, but far more difficult for the less fortunate who are, ostensibly, the ones who need the most help? This is not why most people start businesses (unless, of course, you’re a wellness vendor). It certainly is not why people devote themselves to work, which is supposed to be for securing (hopefully) individual and familial prosperity and experiencing the unique contribution to personal dignity that comes from purposeful endeavors.
American employers are not responsible for the chronic disease crisis; truth be told, their sufferance of the costs of many wellness-sensitive events is limited because the majority of the medical catastrophes that health-contingent wellness programs promise to prevent (such as heart attacks, strokes, and many cancers) happen predominantly in older people who have mostly left the work force. Employers have been caught up in the maelstrom of demographic, industrial, and technological changes just like the rest of us. Yet, not only do we actively seek their participation in fishing expeditions such as health-contingent workplace wellness programs, some of them jump in with both feet. This should help to remind you that your CEO might just be the one who graduated at the bottom of his class.
Should employers want everyone to be hale and hearty? Of course. I want everyone to be hale and hearty and to live an absurdly long, healthy, prosperous life. It’s just not clear that the path to health is paved with health risk appraisals, biometrics, and cost-shifting the burden of higher premiums on to the backs of people who, for whatever reason, could not master the four fundamental tasks written at the beginning of this piece.
Organizational cultures should be configured around health centric messaging and tools that help people voluntarily, and by following exemplary health leaders, elevate themselves and change the trajectory of their health lives. But, the intrusive and coercive nature of health-contingent wellness programs is the most demeaning kind of paternalism.
If you are comfortable today with the notion that your employer should be your parent, consider this: another function of highly engaged parents is to punish when things don’t go as expected.
Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness. This op-ed was adopted from his blog, Khanna On Health.
