# Tying health insurance to your job is dumb and bad. So why are we still doing it? **URL:** \ **Category:** Great Debates\ **Created:** [October 8, 2014, 7:44am UTC](https://boards.straightdope.com/t/tying-health-insurance-to-your-job-is-dumb-and-bad-so-why-are-we-still-doing-it/700734 "2014-10-08T07:44:09Z")\ **Posts on this page:** 6\ **Page:** 3
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [October 10, 2014, 5:25am UTC](https://boards.straightdope.com/t/tying-health-insurance-to-your-job-is-dumb-and-bad-so-why-are-we-still-doing-it/700734/41 "2014-10-10T05:25:32Z")
> [@Grim\_Render](#): > > I am only speculating here, but it does seem to me that there must be some reason why business doesn’t seem particularly interested in getting medical insurance costs off their backs. They are competing with foreign industries that do not carry that weight, after all. Industries in single payer countries DO carry at least part of that weight, but it’s in the form of government-mandated payments (sometimes they get called taxes and sometimes something else) which are calculated in the same way for everybody, rather than something each company needs to figure out. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [October 10, 2014, 6:11am UTC](https://boards.straightdope.com/t/tying-health-insurance-to-your-job-is-dumb-and-bad-so-why-are-we-still-doing-it/700734/42 "2014-10-10T06:11:10Z")
> [@bump](#): > > My company used to be one of the country’s largest providers of those sorts of services, and I worked in the IT group that supported that business unit, and I haven’t ever heard of there being mandatory doctor visits based on the rinky-dink physicals that we used to do all the time. > > Typically, the wellness screenings don’t actually translate into mandated doctor visits, but they often do translate into discounts if your numbers are below some threshold. So if you had BP under say… 120/80, you got $20 per month off your premiums. If it was under 130/90, you got $10 off per month, and you paid full freight for anything above that. There are usually a small set of tests that worked for this, and some automatic crash landings- if you were too fat, or you smoked, you didn’t qualify for full discounts, no matter what your numbers were. > They also do questionnaires and based on the results of those, may try and coerce you into doing ‘health coaching’ which is basically having to meet with some chump who is called a “health coach” or something like that, and they basically tell you what you already know- to eat healthier, don’t smoke, don’t drink so much, and exercise more. > > Of course, they’ll suggest that you go see a doctor if your numbers are in certain ranges- for example, my company had 4 ranges, IIRC for BP- there was the “Awesome!” range, which was 120/80 or below, the “OK, but you should see a doctor”, which was like 121/81 to like 135/90, the “You REALLY need to see a doctor” range, which was higher than 135/90, and the “HOLY SHIT! Your brain is about to burst” range, which was something absurd and life threatening, and IIRC, they usually offered to call an ambulance for those people. I work in population health management, which involves a lot of healthcare data analysis and reviews of clinical guidelines. My company analyzes risk measures and quality of care being received by a patient and by a client’s total population at large. We just do the data, so we don’t have any pressure to make numbers lower or higher for certain measures. Wellness fairs have a lot of problems associated, including dispensing outdated or invalid clinical advice, using outdated guidelines, not providing context for tests taken (such as the blood pressure example, above). But the problem comes with the wellness programs, not necessarily the fairs. Because the fair is the \*first \*step. There is pressure on employees to “get their numbers down”, which does lead to additional visits and tests and medication. Yes, this is potentially beneficial to the employee and a long-term savings (though generally after the employee has retired), _but it will not be a short-term savings_, and companies must understand that. (Too many do not, BTW, based on client questions that I get.) Wellness programs also do a good deal of _cough_ creative accounting of the numbers. [For example, the state of Nebraska claimed a few years ago that its workplace wellness program saved over 500 lives from cancer…when the patients did not have cancer at all, only benign polyps of the colon (which are common among folks in middle and older years).](http://www.dismgmt.com/ida/2013/nebraska_state) Al Lewis (one of the originators of the idea of workplace wellness, now a critic at how it’s being carried out) pointed out in one of his books that Nebraska claimed $4.2 million in savings even though only 186 people’s risk declined, and claimed a 3% reduction in use of chronic disease medications even though they diagnosed an extra 40% of the population with a chronic disease needing medication. This is only one example out of dozens that I can think of off the top of my head. (But it’s late, and I do not want to bore the entire SDMB to death.) It’s possible that you don’t see it in the IT side of things, but I do know how data is repackaged and massaged before it’s presented to the clients to “prove” savings. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [October 10, 2014, 6:17am UTC](https://boards.straightdope.com/t/tying-health-insurance-to-your-job-is-dumb-and-bad-so-why-are-we-still-doing-it/700734/43 "2014-10-10T06:17:00Z")
> [@Mighty\_Mouse](#): > > The employer will get sick of paying tens of thousands more for old and sick employees than young healthy ones. Unless they’re upper management… ---
**Author:** ![Buck\_Godot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/buck_godot/32/6573_2.png) [@Buck\_Godot](https://boards.straightdope.com/u/Buck_Godot)\ **Post date:** [October 10, 2014, 3:41pm UTC](https://boards.straightdope.com/t/tying-health-insurance-to-your-job-is-dumb-and-bad-so-why-are-we-still-doing-it/700734/44 "2014-10-10T15:41:21Z")
> [@septimus](#): > > I certainly agree with OP. HOWEVER, employer-sponsered insurance has one big advantage that disappears if insurance is purchased individually. > > When a large company insures _all_ its employees, the insurance company need not evaluate risks case-by-case. They know they’ll lose money on some of the insured (people with chronic ailments) but make it up with the healthy insured. > > When policies are purchased individually (with healthy people having an incentive not to insure at all), insurance companies have to assess each applicant’s health. That is my impression as well. With the Obamacare mandate and elimination of pre-existing condition restrictions, hopefully this will no longer be a factor. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [October 10, 2014, 4:33pm UTC](https://boards.straightdope.com/t/tying-health-insurance-to-your-job-is-dumb-and-bad-so-why-are-we-still-doing-it/700734/45 "2014-10-10T16:33:28Z")
> [@Buck\_Godot](#): > > That is my impression as well. With the Obamacare mandate and elimination of pre-existing condition restrictions, hopefully this will no longer be a factor. The ACA has a [risk adjustment payment](http://kff.org/health-reform/issue-brief/explaining-health-care-reform-risk-adjustment-reinsurance-and-risk-corridors/) that will offset this. So if Program A has 10 healthy people and 2 sick people, and Program B has 2 really sick people, 4 people with chronic health problems, and 6 healthy people, an offset payment will be made from A to B to equalize the pool. It’s complicated, as you’d expect; more details at the link. ---
**Author:** ![bump](https://avatars.discourse-cdn.com/v4/letter/b/7c8e57/32.png) [@bump](https://boards.straightdope.com/u/bump)\ **Post date:** [October 13, 2014, 3:15pm UTC](https://boards.straightdope.com/t/tying-health-insurance-to-your-job-is-dumb-and-bad-so-why-are-we-still-doing-it/700734/46 "2014-10-13T15:15:10Z")
> [@GrumpyBunny](#): > > It’s possible that you don’t see it in the IT side of things, but I do know how data is repackaged and massaged before it’s presented to the clients to “prove” savings. Our reporting was pretty much aggregate type stuff, along the lines of saying that according to BMI, W% was underweight, X% was normal, Y% was overweight and Z% was obese. Or that some percentage was potentially diabetic, or smokes, or whatever. How the customer service and sales people spun that stuff to the clients in terms of savings and/or ROI, I don’t know exactly, but I do agree that it’s probably kind of sketchy, just because it’s all statistically based, and the sorts of people presenting and consuming that information like more solid savings/ROI numbers than a statistical guess as to what might happen in 15 years time. [Previous page](https://boards.straightdope.com/t/tying-health-insurance-to-your-job-is-dumb-and-bad-so-why-are-we-still-doing-it/700734.md?page=2)