Tuesday, July 17, 2007

The Health Care State

In his speech in behalf of the Barry Goldwater presidential campaign, Ronald Reagan stated the following:

You and I are told increasingly that we have to choose between a left or right, but I would like to suggest that there is no such thing as a left or right. There is only an up or down--up to a man's age-old dream, the ultimate in individual freedom consistent with law and order--or down to the ant heap totalitarianism, and regardless of their sincerity, their humanitarian motives, those who would trade our freedom for security have embarked on this downward course.

Those thoughts should be kept in mind when considering the various calls for government to step in and solve what is being termed a health care crisis. Whenever the government decides to pay for something, it always also, with some good reason, exercises its right to maintain some control over what it has agreed to pay for. Americans have up until now opted for a health care payment system that relies on a combination of government and employer based insurance coverage. As costs continue to grow, the notion is gaining currency that those costs are not borne individually, but societally. That being the case, more people are beginning to clamor for greater societal control over individual life style choices that would tend to increase healthcare costs. The implications of that should be disturbing.

Those thoughts came to mind today during a meeting I attended on the subject of prospective mandatory wellness programs (regrettably, I will not be able to cite sources for this post). An increasing number of employers are beginning to offer wellness programs to their employees involving such things as onsite health screenings, weight loss programs, smoking cessation classes, health tips, and so forth. While many of these have been shown to be effective in reducing employer health care costs, many employer groups are arguing that this is not enough. They contend that more aggressive, mandatory programs should become common place. They also make clear that laws protecting individual privacy or prohibiting discrimination against various groups should not be allowed to get in the way of such programs.

Thus, a court case is now pending in Massachussetts, where an employee was fired for not following the company's wellness requirements, as revealed by a failed nicotine test. Advocates of this approach argue that employers should be allowed to reduce employee health benefits if employees are "preventably obese." They also argue that employers might be allowed to condition a job offer or benefit levels on an employee's agreement to participate in an exercise program. It was further stated that it is not sufficient merely to have "goals" for such programs: requirements must be mandated as standards for employment or benefits.

The attorney presenting these notions contends that the costs of health care to employers -- and to government -- provide adequate justification for these intrusions on "personal lifestyle choices." In fact, for those who protested what this would do to employer/employee relations, he offered as a worse alternative an example from England, where he said that persons could not have certain surgical procedures unless they certified that they had been smoke free for 60 days. The presenter also used militant language in arguing that these mandatory programs must be implemented -- "recognition of wellness as a corporate asset demands a full-fledged attack;" "have to be ruthless;" "unstoppable force" -- along with nanny state lingo (repeated references to "tough love").

What was surprising to me was the extent to which the audience accepted these notions as the inevitable wave of the future -- a friend attending along with me (a mainstream conservative businessman), expressed frustration at how unhealthy people drive up company health care costs and expressed support for these ideas. I find them alarming. I am all for wellness. But allowing employers -- and ultimately the government -- to define healthy living and then insist I abide by it, or else, is more intrusion into my private sphere than I can accept.


Anonymous Martin Kennedy said...

... But allowing employers -- and ultimately the government -- to define healthy living and then insist I abide by it, or else, is more intrusion into my private sphere than I can accept...

Then you favor gradual governmental withdrawal from the provision of health care? That is the implication, or am I missing something?

1:25 PM  
Blogger MCO said...

Martin, I would favor a move toward market based reforms, but at the very least hope that people will begin to question what seems to be a drive toward socialized medicine.

There are two important, broad questions that deserve discussion in the current health care debate: who has access to health care coverage, and why are health care costs rising so dramatically. Unfortunately, only the former is getting real attention, in spite of the fact that the second is more fundamental to what currently ails the system. The government based solutions currently under discussion will only succeed in shifting ever growing costs to taxpayers.

There are some market based reforms that could lead to solid results, but those are not currently under serious consideration.

3:33 PM  

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