# Health Care costs, Wellness, and the Nanny State **URL:** \ **Category:** Great Debates\ **Created:** [October 16, 2011, 11:47pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860 "2011-10-16T23:47:00Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Typo\_Knig](https://avatars.discourse-cdn.com/v4/letter/t/cdc98d/32.png) [@Typo\_Knig](https://boards.straightdope.com/u/Typo_Knig)\ **Post date:** [October 16, 2011, 11:47pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/1 "2011-10-16T23:47:00Z")
Today’s Washington Post had an [article](http://www.washingtonpost.com/blogs/ezra-klein/post/the-promise-and-peril-of-wellness/2011/08/25/gIQAGzPfkL_print.html) on the successes the Cleveland Clinic has had reducing health care costs for its employees. They’ve taken wellness incentives to a whole new level - to the point where smoking has gotten people fired, and _not_ using the gym costs employees big $$ in their insurance premiums. I am of mixed feelings about this. The cost savings for the Cleveland Clinic are stunning - health care expenses actually declined! At a non-monetary cost of the employer getting very deep into the employees’ personal business. Why should my employer care if I smoke, drink, eat too much, exercise too little, etc.? Because it ends up costing them money, that’s why. If one expands this to society as a whole, everything becomes the business of The State. That concept gives _me_, a quiche-eating liberal, significant concern. What say ye Dopers? Please read the article before you comment - it’s only one page long, and I’m sure I skipped important points in my overview. I’m looking forward to what people across the political spectrum have to say. ---
**Author:** ![Oakminster](https://avatars.discourse-cdn.com/v4/letter/o/77aa72/32.png) [@Oakminster](https://boards.straightdope.com/u/Oakminster)\ **Post date:** [October 16, 2011, 11:54pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/2 "2011-10-16T23:54:39Z")
Way too intrusive into personal decisions. I hate it, and will campaign vigorously against any politician that endorses this crap. ---
**Author:** ![Typo\_Knig](https://avatars.discourse-cdn.com/v4/letter/t/cdc98d/32.png) [@Typo\_Knig](https://boards.straightdope.com/u/Typo_Knig)\ **Post date:** [October 17, 2011, 12:01am UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/3 "2011-10-17T00:01:45Z")
> [@Oakminster](#): > > Way too intrusive into personal decisions. I hate it, and will campaign vigorously against any politician that endorses this crap. What about businesses? Is it legal for companies to not hire smokers, to have employees pay huge penalties for “bad” lifestyle behaviors, etc.? Life insurance costs more for smokers, and for mathematically unassailable reasons - so why not health insurance? The slope does not get any slipperier than with this issue. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [October 17, 2011, 12:03am UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/4 "2011-10-17T00:03:33Z")
Supposing you opt out of their health program. Do the rules still apply? Can you opt out? I can’t tell form the linked article. ---
**Author:** ![bahia\_hombre](https://avatars.discourse-cdn.com/v4/letter/b/87869e/32.png) [@bahia\_hombre](https://boards.straightdope.com/u/bahia_hombre)\ **Post date:** [October 17, 2011, 12:07am UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/5 "2011-10-17T00:07:52Z")
Nobody’s forced to work there. The CC is doing them a huge favor…they should be grateful. The only problem I see is they glossed right over the stress reduction part. Classes, yeah, but what is CC doing to reduce stress on the job? ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [October 17, 2011, 12:19am UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/6 "2011-10-17T00:19:24Z")
The data is collective. That does not mean that you could not eat badly and live a sedentary life and die at 90. I think to do anything to you, they should have to prove that your lifestyle is costing them money or harming your life. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [October 17, 2011, 12:48am UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/7 "2011-10-17T00:48:17Z")
Good for them. No one has to work there. If you want to work there, you have to follow their rules. None of which appear to me to impermissibly affect protected areas such as religion or sexual preference or practice. I have no heartburn at all with an employer doing this. The government, in contrast, would be another matter. ---
**Author:** ![Oakminster](https://avatars.discourse-cdn.com/v4/letter/o/77aa72/32.png) [@Oakminster](https://boards.straightdope.com/u/Oakminster)\ **Post date:** [October 17, 2011, 1:34am UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/8 "2011-10-17T01:34:38Z")
> [@Bricker](#): > > I have no heartburn at all with an employer doing this. Bad for them and a pox on their houses. I have considerable heartburn with a private company doing this. Unfortunately, I do not have a legal reason they should not be allowed to do it. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [October 17, 2011, 1:48am UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/9 "2011-10-17T01:48:49Z")
> [@Bricker](#): > > Good for them. No one has to work there. If you want to work there, you have to follow their rules. None of which appear to me to impermissibly affect protected areas such as religion or sexual preference or practice. I have no heartburn at all with an employer doing this. > > The government, in contrast, would be another matter. That distinction between corporate control of a persons life vs government control doesn’t make sense to me. A person can emigrate from their country, or emigrate from their state just as they can quit their job. Would you consider a city gov. law different from a state or federal government law on this issue? ie, if NYC bans smoking, how would you feel if someone said ‘nobody has to live in NYC, they can move’. If New York state bans it would you feel the same way if someone said move to another state? What about a nationwide ban and someone said move to another country? The distinction between ‘you can quit your job’ and ‘you can move out of City/State/Country X’ isn’t really that big of a difference to me. As far as the OP, the thing they leave out of that article is the fact that preventative medicine really doesn’t save money in the long run. It may lower annual costs, but people end up living longer and getting sick from other diseases. At the end of the day the medical cost is roughly the same (plus you have more years of social security to pay out). It isn’t the slam dunk it is made out to be. People who avoid smoking, eat healthy, exercise and reduce their stress die every day just like everyone else. Being thin and exercising may prevent diabetes, but it won’t prevent your organs from slowly failing when you are 85. [http://prescriptions.blogs.nytimes.com/2009/08/18/the-problem-with-prevention/](http://prescriptions.blogs.nytimes.com/2009/08/18/the-problem-with-prevention/) This study finds smokers and the obese actually cost less than thin non-smokers when you add in extra life expectancy. > **[PLOS Medicine](https://journals.plos.org/plosmedicine/)** > [@](#): > > With a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and “healthy-living” persons (defined as nonsmokers with a body mass index between 18.5 and 25). Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. **Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position.** Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions. If the goal is to save money, it may not work. I’d need evidence of this 300-600 billion a year in savings. People are still going to get sick and die, people will still collect SS money, and people will still spend their final years in slowly failing health. Plus where does ‘wellness’ end? Smoking, obesity, inactivity and poor diet are all unhealthy. So is having a poor work/life balance. So is engaging in risky recreational activities (skydiving, mountain climbing, race car driving). So is not consuming 2 alcoholic drinks a day. So is not being married (if you are a man, married men have several years more life expectancy than unmarried single men). So is not having close friends. So is poverty. So is not having a sense of humor. Where do they draw the line? If they can ban smoking, who is to say they can’t ban unmarried men or people who go skydiving on the weekends? All are damaging to health. And why does preventative medicine/wellness always go in the direction of nagging people to change their lifestyle? Why can’t wellness target social causes of health problems? Environmental pollution, poverty, lack of universal health care, etc. all contribute to poor health. Nobody focuses on that, we just yell at fat people. There is no ‘war on poverty’ in the name of medicine, but there should be if we are going to start acting like the clinic in the OP acts. Poverty cuts years off of life expectancy. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [October 17, 2011, 2:37am UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/10 "2011-10-17T02:37:32Z")
> [@](#): > > As far as the OP, the thing they leave out of that article is the fact that preventative medicine really doesn’t save money in the long run. It may lower annual costs, but people end up living longer and getting sick from other diseases. At the end of the day the medical cost is roughly the same (plus you have more years of social security to pay out). It isn’t the slam dunk it is made out to be. People who avoid smoking, eat healthy, exercise and reduce their stress die every day just like everyone else. Being thin and exercising may prevent diabetes, but it won’t prevent your organs from slowly failing when you are 85. Does that analysis factor in that health itself has value, and so more years of health have more value? In the simplest case, consider that someone who gets sick at 40 rather than at 80 is going to be missing work and not contributing during that time. ---
**Author:** ![brickbacon](https://avatars.discourse-cdn.com/v4/letter/b/898d66/32.png) [@brickbacon](https://boards.straightdope.com/u/brickbacon)\ **Post date:** [October 17, 2011, 4:00am UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/11 "2011-10-17T04:00:36Z")
> [@Chronos](#): > > Does that analysis factor in that health itself has value, and so more years of health have more value? In the simplest case, consider that someone who gets sick at 40 rather than at 80 is going to be missing work and not contributing during that time. Generally, they factor in those things, but studies vary on the benefits of preventative care. While you are right about health itself having value, most of that value is only important to the individual (eg. more time with kids, etc). [Here](http://www.nejm.org/doi/full/10.1056/NEJMp0708558) is one such study that weighs in on the issue. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [October 17, 2011, 12:55pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/12 "2011-10-17T12:55:18Z")
> [@Wesley\_Clark](#): > > That distinction between corporate control of a persons life vs government control doesn’t make sense to me. A person can emigrate from their country, or emigrate from their state just as they can quit their job. Would you consider a city gov. law different from a state or federal government law on this issue? ie, if NYC bans smoking, how would you feel if someone said ‘nobody has to live in NYC, they can move’. If New York state bans it would you feel the same way if someone said move to another state? What about a nationwide ban and someone said move to another country? The distinction between ‘you can quit your job’ and ‘you can move out of City/State/Country X’ isn’t really that big of a difference to me. The question isn’t how easily you can avoid the reach of an unwelcome rule. The question is the role the rulemaker has in your life. Your and your company are both private actors. Your company has only the power you grant it in a contractual relationship. You city, state, and federal government have sovereign power over you. They are constrained by the law and the principles that are implicit to our concept of ordered liberty. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [October 17, 2011, 1:49pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/13 "2011-10-17T13:49:17Z")
> [@article](#): > > The clinic tracks its employees’ blood pressure, lipids, blood sugar, weight and smoking habits. My BP is low, my cholesterol is fine, I’d like to know what the heck do they exactly mean by tracking “lipids”, my blood sugar is fine, I don’t smoke… and if my weight goes below what’s officially the upper limit of my “ideal weight”, my period goes MIA :mad: I don’t see how the blazes is my weight my employer’s business, so long as it doesn’t keep me from doing my job. Since my tonsillitis surgery in 4th grade, I’ve missed less than ten days of school or work for health reasons: five due to gastrenteritis, one due to being overtired thanks to my boss’ idiocy, the rest were infectious diseases. None of them is weight-related. I wouldn’t take a job with a company that tells me I have to go to the gym every Saturday morning Or Else. Among other things, right now it would be cutting into the time I’m spending sanding and painting three rooms all by myself - which may not be exercise but it sure leaves you tired! ---
**Author:** ![ITR\_champion](https://avatars.discourse-cdn.com/v4/letter/i/c67d28/32.png) [@ITR\_champion](https://boards.straightdope.com/u/ITR_champion)\ **Post date:** [October 17, 2011, 3:26pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/14 "2011-10-17T15:26:36Z")
> [@Typo\_Knig](#): > > and _not_ using the gym costs employees big $$ in their insurance premiums. This part strikes me as unworkable. Consider me. If go hiking or bike riding on almost every day off. I spend my vacations backpacking and climb 10,000-foot mountains. I do hundred-mile charity bike rides when I can. I also do rafting, kayaking, canoeing, and I coach my school’s cross-country team. But I’m utterly uninterested in going to the gym or a yoga class, so according to the article I’d lose money if I worked at this place. ---
**Author:** ![code\_grey](https://avatars.discourse-cdn.com/v4/letter/c/f4b2a3/32.png) [@code\_grey](https://boards.straightdope.com/u/code_grey)\ **Post date:** [October 17, 2011, 5:55pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/15 "2011-10-17T17:55:33Z")
so, when will they start firing all non-vegetarian non-yoga-practitioners who refuse to acknowledge the marvelous health benefits of meditation? “We are an evil totalitarian cult, and that’s why our employees’ _wellness_ is our first priority. _Research has shown_ that being a slave is good for you”. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [October 17, 2011, 6:23pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/16 "2011-10-17T18:23:39Z")
> [@John\_Mace](#): > > Supposing you opt out of their health program. Do the rules still apply? Can you opt out? I can’t tell form the linked article. My wife works for a healthcare administrator with a similar program, and that’s how their system works. It’s illegal to _increase_ employees’ health plan contributions based on unhealthy lifestyle choices (due to various provisions of ERISA, the Pension Plans Disclosure Act, and some other federal employment legislation). It’s not illegal to offer employees a discount for making _healthy_ choices, though. So the wife gets ~3% off her annual premium cost for attending an annual biometrics and physical appointment at the in-house clinic, some nominal sum for not smoking (or would, if she didn’t smoke), and so on. ---
**Author:** ![Odesio](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/odesio/32/20003_2.png) [@Odesio](https://boards.straightdope.com/u/Odesio)\ **Post date:** [October 17, 2011, 6:27pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/17 "2011-10-17T18:27:12Z")
I can picture it now. The year is 1905 and I work as a brakeman for the rail road company. I exit a saloon and run into my supervisor. Being a moderate drinker I am not drunk but the smell of beer is plainly upon my breath. I am not working this day nor will I be working tomorrow. Unfortunately, my supervisors are concerned about intemperate individuals in their employ for fear of accidents which they might be held liable. For this reason, I am fired when I return to work. The more things change… ---
**Author:** ![Roderick\_Femm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/roderick_femm/32/14875_2.png) [@Roderick\_Femm](https://boards.straightdope.com/u/Roderick_Femm)\ **Post date:** [October 17, 2011, 9:32pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/18 "2011-10-17T21:32:22Z")
> [@Bricker](#): > > The question isn’t how easily you can avoid the reach of an unwelcome rule. The question is the role the rulemaker has in your life. > > Your and your company are both private actors. Your company has only the power you grant it in a contractual relationship. > > You city, state, and federal government have sovereign power over you. They are constrained by the law and the principles that are implicit to our concept of ordered liberty. Very nicely put. One problem I have with our current sort-of state capitalism is that, due to the law, many apparently private companies have far more control over our lives than they ought to have, and free choice can be very limited or completely absent. Fortunately, so far at least in California, this lack of choice does not extend to employment. But (referring back to the OP) it is not inconceivable that the difference that you clearly note between companies and governments would be glossed over by politicians eager to promote national health care. Roddy ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [October 17, 2011, 9:57pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/19 "2011-10-17T21:57:33Z")
> [@Odesio](#): > > I can picture it now. The year is 1905 and I work as a brakeman for the rail road company. I exit a saloon and run into my supervisor. Being a moderate drinker I am not drunk but the smell of beer is plainly upon my breath. I am not working this day nor will I be working tomorrow. Unfortunately, my supervisors are concerned about intemperate individuals in their employ for fear of accidents which they might be held liable. For this reason, I am fired when I return to work. > > The more things change… Or you could smoke pot at a concert on saturday and show up for work on monday and fail a drug test. Same thing. ---
**Author:** ![Icarus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/icarus/32/72_2.png) [@Icarus](https://boards.straightdope.com/u/Icarus)\ **Post date:** [October 17, 2011, 10:12pm UTC](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860/20 "2011-10-17T22:12:59Z")
The issue for me in this is the draconian prospect of firing an employee who smokes or charging $$ to an employee who does not go to the gym. I understand that companies want to reduce cost of insuring employees. One avenue is to buy cheaper insurance (which offers less coverage), another is to pass a greater amount of the cost one to the employee. Recently the whole wellness aspect has provided another avenue to reduce costs. These are all fine, I suppose. But they have taken it over the line in punishment for not playing. Sort of a cart-before-the-horse problem. Sure, incent good behavior, discourage bad behavior, but there is a spectrum between discourage and punish with firing. [Next page](https://boards.straightdope.com/t/health-care-costs-wellness-and-the-nanny-state/599860.md?page=2)