Prudent management or lifestyle dictatorship?


Hiking heath insurance rates for people with unhealthy lifestyles is becoming an increasingly accepted element of the U.S. healthcare puzzle. But how far should employers be able to go in dictating the personal lifestyle of their staff?

A Wall Street Journal/Harris Poll released earlier this week found that public sentiment is shifting towards acceptance of higher health insurance rates for people with unhealthy lifestyles.

Half of those surveyed (53 percent) said they think it's fair to ask people with unhealthy lifestyles to pay higher insurance premiums than people with healthy lifestyles, while only a third said it would be unfair.

When asked the same question in 2003, 37 percent said it would be fair, while 45 percent said it would be unfair.

According to John Shull, chief executive of Nashville-based Gordian Health Solutions, this change in attitudes is giving human resources executives new ammunition to introduce employee health plan designs with incentives to pursue healthier habits.

One strategy that is gaining ground in corporate America is providing financial incentives, such as lower premiums or co-payments, for employees who choose healthy behaviours like smoking cessation, exercise and weight control.

"As health care costs continue to rise, more consumers can see the logic of giving employees who make healthier lifestyle choices a break," Shull said.

"Most chronic illnesses are tied to lifestyle-driven choices such as poor diet, lack of exercise or smoking.

"When offered a choice of lower health care premiums, along with the programs and health coaching to help them succeed in living a healthier life, employees have all the right reasons to make changes." Shull added that businesses can also create a more positive climate if employees are presented with financial incentives (or discounts) to be healthier rather than higher premiums or co-pays for unhealthy lifestyle choices.

A more positive climate often means greater participation in healthy lifestyle programs, and lower overall health care costs for the employer, he said.

But while such a policy might seem attractive on the surface, it raises serious questions as to how far employers should be able to dictate the personal lifestyles of their staff.

Last year, for example, a Michigan-based company, Weyco, Inc., hit the headlines for firing employees for refusing to take a test to see if they use tobacco products.

And as Management-Issues columnist Dan Bobinski asked at the time, what's next?

"With companies adopting (and getting away with) this "save-on-health-care-cost" mentality, it won't be long before they're banning obese people from their ranks. And those who ride motorcycles, go hunting, kayaking, scuba diving, or rock-climbing will also be forced to give up their "dangerous" (but legal) activities.

"When it gets to this point, which "sin" of yours will be put on the chopping block?"

There is no problem with employers banning certain activities from company property, enforcing drug or alcohol testing to make sure employees are sober at work, or banning conflicts of interest, Bobinski argued.

"But when employers dictate what employees can or cannot do on their own time, either in the privacy of their own homes or in other, private establishments, I believe they have crossed the line. Big time."