The Liberty Papers

A bit of a furor erupted last year, when a company decided to fire current employees who smoke, and no longer hire smokers. The debate centered around the question of whether an employee paying for your health care could force you to cease unhealthy habits.

This was a bit of a debate, but for the most part, nobody outside of some libertarians really stuck up for the smokers, because smokers are “icky” and nobody likes them. Discrimination against hated minorities rarely results in condemnation. Now, though, a health-care company is raising the stakes, by telling their own employees they’ll be fined for poor health:

For employees at Clarian Health, feeling the burn of trying to lose weight will take on new meaning.

In late June, the Indianapolis-based hospital system announced that starting in 2009, it will fine employees $10 per paycheck if their body mass index (BMI, a ratio of height to weight that measures body fat) is over 30. If their cholesterol, blood pressure, and glucose levels are too high, they’ll be charged $5 for each standard they don’t meet. Ditto if they smoke: Starting next year, they’ll be charged another $5 in each check. It is understandable for people to think this crosses some sort of line. This essentially means that a company has shares in your health and consequentially, they want to see a decent return on their investment. Maybe, as workers, we are more accustomed to employees trying to improve us in a professional sense rather than our health. Things like workplace mentoring have been common for a long period of time, but an obsession with our BMI is relatively new.

More of this, of course, is inevitable. Government intervention has created huge incentives for employers to provide healthcare to workers and made it nearly impossible for workers to self-insure. However, some companies may have decided to introduce a health insurance plan for employees, to help them receive more benefits from this type of plan. For example, small businesses may decide to self-insure their employees so that it has a better chance of suiting their healthcare needs. When it comes to having healthcare for your business, it is easier than many people may think. As health should be the top priority, it makes sense for employers to put this in place for their staff.

At the same time, anti-discrimination laws have made it impossible for employers to revoke coverage for high-risk individuals. Due to this (and a host of other interventions), healthcare costs are skyrocketing and employers are looking for any way to cut costs. But the government has offered some clarification that relaxed the rules, and companies are taking advantage of it.

In addition, regulations that became effective July 1 could prompt cautious employers to step off the sidelines. The federal government recently issued final rules on how wellness programs could comply with the nondiscrimination conditions of the Health Insurance Portability & Accountability Act (HIPAA). While the new regulations have been proposed for years, the final rules provide employers with some sense of security and more clarification on how much they can reward or penalize employees based on specific health results. “When you get into things that involve discrimination, employers aren’t very comfortable with the words ‘proposed regulation,'” says Jerry Ripperger, director of consumer health for the Principal Financial Group, a financial-services and insurance firm that offers wellness programs for large employers. In fact, many would propose other means to go about improving employees morale and health over systems like this.

So put the two together, and employers are going to do anything in their power to cut their healthcare premiums. Of course, anything in their power must take into effect employee morale, especially in an economy with low unemployment, where the desire to hire and retain talent requires that you keep those employees happy. And some employees may not be happy:

Clarian Health admits that its program is aggressive by design, and that employee reaction has been mixed, with much debate on its internal message boards. While some employees were supportive, there’s been “the other reaction that this is very personal,” says Wantz, with people asking, “‘How dare you? This is my personal space.’ There’s been a lot of questions and confusion.”

Herein lies the problem. Most people don’t like being told what they must do with their bodies. They don’t like it especially when it’s their employer, a relationship that already has the potential to be adversarial. But employees are incorrect when they refer to this as “personal” space. Insure yourself, and it’s personal space. Expect someone else to pay your health insurance premiums, and it no longer affects just you. I can guarantee that most employees will not like this development, but as I’ve always said with government, money and control come hand in hand. You’re taking their money, and you’re surprised they want to keep their costs down by keeping you in a low-risk group?

Sadly, while I support such efforts by companies to set their own insurance policies, I fear that this will lead to the wrong backlash. If more employers head down this road, it will only increase the call for single-payer socialized medicine. Americans don’t want to pay for their own health care, and certainly don’t want their boss telling them to drop a few pounds. To them, the only alternative will be government.

Government control won’t help, of course. Government will have the same (likely worse) rationing problems that private insurance has. The costs will go through the roof. And if you think your employer telling you what to do and not to do is bad, do you think it will be any better with the government in charge?