January 30, 2012
3:33 pm
If you smoke tobacco, you’re not going to be hired for a job by the Baylor Health Care System. For that matter, you don’t need to waste time filling out an employment application form at the Cleveland Clinic either. Both healthcare providers have made it clear that they will not accept smokers within their respective workforces.
In its editorial today, USA Today says this type of policy is wrong. The newspaper argues that employers like Baylor CEO Joel Allison and Cleveland Clinic CEO Toby Cosgrove (both members of the Healthcare Leadership Council) have every right to offer smoking cessation programs to their employees and even to make smokers pay more out of pocket for their workplace-provided health insurance. But, USA Today says, it is improper to penalize a job applicant for practicing a legal habit on their own time.
According to the newspaper’s editorial, “A bit further down (this) road lies hiring based on genetics. In that world, inheriting that shows a predisposition to a costly disease could cost you a job.”
USA Today is wrong, and not just because of its nonsensical comparison of a voluntary activity like smoking to an individual’s genetic makeup.
Today’s healthcare providers are expected not only to provide excellent care for the patients, but also to encourage wellness, disease prevention and healthy behaviors among all individuals they have the ability to influence. As Dr. Paul Terpeluk of the Cleveland Clinic said in his “opposing view” in USA Today, “We have a unique perspective on the burden of chronic disease. We not only treat disease, but we also play a vital role in educating patients and employees about lifestyle choices. It is only right to practice what we preach.”
There’s also a significant economic issue involved here. When an employer, particularly one who provides health coverage, hires an individual, they are assuming the burden of his or her healthcare costs. An individual may smoke on their own time, but the employer winds up footing much of the bill for the chronic illnesses associated with smoking. Should an employer be allowed to consider the increased health costs, absenteeism and loss of productivity associated with a voluntary, unhealthy behavior like smoking? It’s hard to argue that they shouldn’t.
And in an environment in which five percent of the population is responsible for 50 percent of our healthcare costs, this is a concern that goes well beyond Baylor and the Cleveland Clinic.
I know both Joel Allison and Toby Cosgrove. They are both gentlemen who have dedicated their lives and careers to providing better health to their fellow citizens. Their no-smoking policies are neither mean-spirited nor discriminatory. Rather, they are intended to make a vitally-needed statement about wellness and healthy living both within and outside the confines of their respective institutions.
December 06, 2011
12:53 pm
Vermont is number one. Mississippi is number 50. But, truth be told, every single state has reason for concern.
The United Health Foundation has issued its annual “America’s Health Rankings” report, showing a state-by-state ranking in overall population health. The striking news this year was not that the New England states occupied six of the top 10 positions, but that the nation as a whole is not faring well.
The United report card showed zero overall improvement in America’s health status over the past year. That’s the first time in two decades that our health has showed no upward mobility whatsoever. In fact, over the past decade, the rate of improvement in the nation’s health status is 69 percent less than it was in the 1990s.
It doesn’t take much analyzing to find out the reason. Obesity is up considerably and diabetes cases are escalating in number. This concurs with what the Centers for Disease Control and Prevention has been telling us about chronic disease trends.
As Reed Tuckson of the United Health Foundation board said, the United States is facing a “tsunami of preventable illness.”
The good news is that there are initiatives being developed throughout the country to keep communities and workforces in better health and prevent the onset of chronic disease. The Healthcare Leadership Council has chronicled a number of these in its HLC Wellness Compendium. We shared this document with key staff members on Capitol Hill at a briefing last week.
The better news will occur when we see policymakers taking these successful examples and finding ways to extrapolate them to help larger populations.
We can still hope that, in the future, when states are competing for placement on the United rankings, that the entire competition will be taking place on a higher plane of healthiness.
April 14, 2011
8:01 am
Sure, the topical thing to do in this space today would be to comment on the President’s deficit reduction speech and the contrast between the Obama budget plan and the one put forward by Congressman Paul Ryan (R-WI).
But there will be plenty of time to do that. This debate over our nation’s priorities and how best to reduce the debt will be going on for months to come.
Instead, I wanted to share an item that caught my eye because I found it fascinating that it took someone other than a political or economics journalist to put the current budget wars into a proper perspective. Mark Bittman, the food columnist for The New York Times Magazine, pointed out in an online commentary this week that, by the year 2030, the cost of treating heart disease in the United States will escalate to $800 billion. And incidences of diabetes, according to the Centers for Disease Control and Prevention, are projected to reach a point at which every other American will have either Type 1 or Type 2 diabetes, which will cause cumulative treatment costs to rise to $500 billion.
So that’s over $1 trillion in future costs connected to just two chronic diseases. By comparison, the recent congressional budget fight that almost resulted in the federal government shutting down was over a small fraction of that, $38 billion.
Bittman’s point is that many of our healthcare costs – and, subsequently, costs to taxpayers because of the number of Americans receiving care through Medicare or Medicaid – can be addressed through better diet. He’s right, but the point is bigger and broader than that.
It is going to be impossible to get a grip on future healthcare costs unless our nation makes wellness and disease prevention an urgent priority. Today, the treatment of chronic disease is responsible for 75 cents of every healthcare dollar we spend in this country. And if projections are correct on the significant increases in heart disease, diabetes, pulmonary illness and various cancers, huge budgetary outlays in both the public and private sectors are going to be unavoidable simply to treat a less healthy populace.
Many employers and communities have made tremendous progress in developing incentive programs to encourage individuals to live healthier lifestyles and seek diagnostic tests and preventive care. We need to take these success stories and expand them so they can benefit a nation.
Now, I don’t expect the upcoming budget debates to focus on how we can get more Americans to quit smoking, eat healthier, get exercise and see their doctor for regular exams and blood tests, but if we don’t give wellness and prevention at least as much attention as, say, appropriations for public radio, then aren’t we missing the point?
March 25, 2011
12:21 pm
The one year anniversary of the Affordable Care Act wasn’t the only significant healthcare news this week. Here are links to some interesting and important reports you may have missed.
A study published in Health Affairs documents the savings generated by a major employer, Johnson & Johnson, as a result of employee wellness programs.
A new blood test is in development that can diagnose the risk of diabetes a decade before symptoms begin to appear.
On the subject of diabetes, Novo Nordisk and race car driver Charlie Kimball have teamed to launch a campaign urging patients to speak to their physicians about improved insulin delivery methods.
Could video games have a healthcare value? Experts say they may help discover whether children have vision problems.
The Cleveland Clinic is taking advanced healthcare delivery concepts far beyond U.S. borders, bringing its expertise to Abu Dhabi.
Meet “Sammons Says,” Baylor’s new blog on cancer prevention, treatment & research.
February 15, 2011
11:35 am
Now that gasoline is over three dollars a gallon, I wince a little every time I fill up my car. It would be nice to have the power to simply decree that gas prices be 50 cents lower, but I understand that my pocketbook preferences do not take precedence over basic marketplace factors that range from the cost of oil exploration to rising energy demand in China and India.
There is still an insistence on the part of some, though, that governments should set healthcare prices (more than is already the case in Medicare and Medicaid), regardless of actual cost of producing and delivering healthcare goods and services.
This issue arises because of a report from Boston’s National Public Radio affiliate, WBUR-FM, that the Massachusetts Governor may ask the state legislature for the authority to set the rates that hospitals can charge. That authority would kick in if, after three years, hospitals are requesting increases of more than two percent.
This idea of government setting prices is, of course, neither new nor limited to the Bay State. During the debate over health reform, proponents of a government-run health insurance option cited Medicare as a model of “efficiency” because it establishes the payment levels that physicians and hospitals can receive. That’s fiat, not efficiency. Similarly, there are constantly proposals bandied about to affix price ceilings to virtually every healthcare sector from insurers to pharmaceuticals to medical devices. That’s also the problem with the Independent Payment Advisory Board, scheduled to be implemented as part of the Affordable Care Act. It’s an entity empowered to slash healthcare spending without regard to achieving greater quality or value.
The problem with having government simply decree what any one sector may charge for its services is that this approach ignores the interrelationship between insurers, providers, manufacturers and consumers in determining the value of healthcare services. It also undermines the ability of health system participants to provide greater value through innovation.
There’s no question that we do need to focus on improving healthcare’s affordability. The way to do that, though, is through new, innovative health delivery mechanisms, a greater reliance on evidence-based medicine, a more intense focus on wellness and prevention and strengthening the ability of consumers to be discerning healthcare shoppers.
For government to simply declare that certain prices must be lower may bring a measure of short-term relief, but there’s a price to be paid, whether it’s in the form of cost-shifting, reduced access, impaired quality or less innovation. Just saying a cost is lower isn’t the same as actually making it lower through marketplace mechanisms or greater ingenuity.
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