Medicine
"Personal responsibility" is a politically loaded term. In the context of health care, Democrats accuse Republicans of using it to resist the expansion of insurance benefits, while Republicans counter that making comprehensive health insurance mandatory is paternalistic and potentially unaffordable for many people compared to other less costly options. While the fate of the different health reform blueprints recently passed by the Democrat-controlled House and the Senate remains uncertain, I think it's worthwhile to look at other innovative models of financing health care. You might be surprised to learn that two national grocery chains - Whole Foods and Safeway - are right on the cutting edge.
In August 2009, Whole Foods CEO John Mackey stirred up a small controversy by writing in a Wall Street Journal editorial titled "The Whole Foods Alternative to ObamaCare" (though Mackey later stated on his blog that the newspaper editor was wholly responsible for the provocative title) that his company's high-deductible health insurance plan was superior to both the typical employer-provided insurance model as well as government-sponsored insurance plans then under consideration by Congress. How does the Whole Foods plan work? Employees receive up to $1,800 yearly to deposit into a personal health savings account, which they can spend any way they like, paying full price for all medical services. If an employee's yearly health expenses exceed $2,500, catastrophic health insurance coverage kicks in. The lower premiums allow Whole Foods to provide insurance to more employees at lower cost, and employees pay only for the health care they need, rather than the health care that they might need. Personal responsibility in action.
Safeway has taken the philosophy of encouraging its employees to make intelligent health choices to another level. Based on the principle that the majority of health care expenses result from unhealthy behaviors such as phyiscal inactivity, poor diet, and smoking, in 2005 Safeway began offering insurance premium discounts of up to 50 percent to employees who passed a nicotine screening test and achieve weight, blood pressure, and cholesterol goals. Although the program is voluntary, enough employees have joined in that Safeway's obesity and smoking rates are now 70 percent of the national average and their per capita health care costs have not increased for the past 4 years, according to Safeway CEO Steve Burd.
It's not clear if either the Whole Foods or the Safeway insurance plans will survive health care reform unscathed; the Whole Foods plan, after all, is based on catastrophic insurance, which could be erased by any reform bill that requires comprehensive coverage for all eligible persons. And some argue that imposing financial penalties for lifestyle choices is tantamount to discrimination. But both of these examples tell me that personal responsibility for one's health may be one of the missing ingredients in the current conversation on reform.
- Health Is More Than Medical Care
. Bob Herbert’s column in the New York Times, January 23, 2010, “They still don’t get it”, is one of many recent pieces that articulately criticize the administration for pursuing policies that benefit the wealthy and the elite, and ignore the...
- Proposals To Tax Health Benefits And Institute Individual Mandates
. The July 2, 2009 issue of the New England Journal of Medicine includes a larger-than-usual number of ”Perspectives” articles. Two directly relate to current health-reform efforts. Jonathan Gruber, of MIT, in “A win-win approach to financing health...
- My Take On State Health Insurance Exchanges - Part 1
Regardless of whether or not the Supreme Court strikes down the individual mandate or the entire 2010 health reform law in June, state-based health insurance exchanges are a good idea and, if established, should benefit many working Americans who...
- Dietary Guidelines For Americans Disappoint
Quick: How many milligrams of sodium did you eat during the Super Bowl? If your big game buffet was anything like mine (hot dogs, buffalo wings, fries, and cole slaw), you probably blew through your day’s allowance of sodium in a single meal, according...
- Direct Primary Care: Health Reform's Missing Piece?
Last year, in a blog post titled "the 'single payer' should be you," I profiled the innovative Seattle-based practice Qliance Primary Care, which, rather than billing private or public health insurers, charges patients a flat monthly fee for unlimited...
Medicine
Food for thought on health care reform
"Personal responsibility" is a politically loaded term. In the context of health care, Democrats accuse Republicans of using it to resist the expansion of insurance benefits, while Republicans counter that making comprehensive health insurance mandatory is paternalistic and potentially unaffordable for many people compared to other less costly options. While the fate of the different health reform blueprints recently passed by the Democrat-controlled House and the Senate remains uncertain, I think it's worthwhile to look at other innovative models of financing health care. You might be surprised to learn that two national grocery chains - Whole Foods and Safeway - are right on the cutting edge.
In August 2009, Whole Foods CEO John Mackey stirred up a small controversy by writing in a Wall Street Journal editorial titled "The Whole Foods Alternative to ObamaCare" (though Mackey later stated on his blog that the newspaper editor was wholly responsible for the provocative title) that his company's high-deductible health insurance plan was superior to both the typical employer-provided insurance model as well as government-sponsored insurance plans then under consideration by Congress. How does the Whole Foods plan work? Employees receive up to $1,800 yearly to deposit into a personal health savings account, which they can spend any way they like, paying full price for all medical services. If an employee's yearly health expenses exceed $2,500, catastrophic health insurance coverage kicks in. The lower premiums allow Whole Foods to provide insurance to more employees at lower cost, and employees pay only for the health care they need, rather than the health care that they might need. Personal responsibility in action.
Safeway has taken the philosophy of encouraging its employees to make intelligent health choices to another level. Based on the principle that the majority of health care expenses result from unhealthy behaviors such as phyiscal inactivity, poor diet, and smoking, in 2005 Safeway began offering insurance premium discounts of up to 50 percent to employees who passed a nicotine screening test and achieve weight, blood pressure, and cholesterol goals. Although the program is voluntary, enough employees have joined in that Safeway's obesity and smoking rates are now 70 percent of the national average and their per capita health care costs have not increased for the past 4 years, according to Safeway CEO Steve Burd.
It's not clear if either the Whole Foods or the Safeway insurance plans will survive health care reform unscathed; the Whole Foods plan, after all, is based on catastrophic insurance, which could be erased by any reform bill that requires comprehensive coverage for all eligible persons. And some argue that imposing financial penalties for lifestyle choices is tantamount to discrimination. But both of these examples tell me that personal responsibility for one's health may be one of the missing ingredients in the current conversation on reform.
- Health Is More Than Medical Care
. Bob Herbert’s column in the New York Times, January 23, 2010, “They still don’t get it”, is one of many recent pieces that articulately criticize the administration for pursuing policies that benefit the wealthy and the elite, and ignore the...
- Proposals To Tax Health Benefits And Institute Individual Mandates
. The July 2, 2009 issue of the New England Journal of Medicine includes a larger-than-usual number of ”Perspectives” articles. Two directly relate to current health-reform efforts. Jonathan Gruber, of MIT, in “A win-win approach to financing health...
- My Take On State Health Insurance Exchanges - Part 1
Regardless of whether or not the Supreme Court strikes down the individual mandate or the entire 2010 health reform law in June, state-based health insurance exchanges are a good idea and, if established, should benefit many working Americans who...
- Dietary Guidelines For Americans Disappoint
Quick: How many milligrams of sodium did you eat during the Super Bowl? If your big game buffet was anything like mine (hot dogs, buffalo wings, fries, and cole slaw), you probably blew through your day’s allowance of sodium in a single meal, according...
- Direct Primary Care: Health Reform's Missing Piece?
Last year, in a blog post titled "the 'single payer' should be you," I profiled the innovative Seattle-based practice Qliance Primary Care, which, rather than billing private or public health insurers, charges patients a flat monthly fee for unlimited...