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.
October 18, 2011
10:59 am
This past Sunday, Ezra Klein had a fascinating piece on the Washington Post website regarding the Cleveland Clinic (a Healthcare Leadership Council member) and its efforts to achieve a higher degree of wellness within its workforce.
In Cleveland, Clinic CEO Delos Cosgrove has essentially declared war against preventable chronic disease. Smoking is completely banned anywhere on the campus (and, in fact, physicians have been fired for violating this prohibition), deep fryers and sugared sodas have been removed from the Clinic premises, and Clinic employees pay higher health insurance premiums if they don’t take part in some form of fitness or stress management classes. Employees’ health conditions – blood pressure, blood sugar, weight and other measurable – are monitored to make sure they are being proactive in improving their health.
The results, as Klein writes, are indisputable. The Clinic has reduced its employee healthcare costs. Smoking rates and blood pressure are way down. Employees have lost a collective 125 tons of weight since 2005.
There will undoubtedly be disagreements over whether the Clinic’s tough love approach is an appropriate policy. And if the same policies were brought to a large non-healthcare workforce like a General Motors or a Xerox, one could even project that there would be charges of discrimation against smokers, the obese and people who just happen to love a Wendy’s Baconator.
But this is a conversation that America needs to have. At the same time in which policymakers are debating whether to cut reimbursement levels in the Medicare program, affecting access to quality care and medical innovation, there are billions of dollars being spent to treat cases of diabetes, heart disease, pulmonary illness and other conditions that are caused or exacerbated by lifestyle choices.
Employees and healthcare providers throughout the country are developing innovative ways to strengthen wellness and prevent chronic disease. We’ve chronicled many of the very effective ones in the HLC Wellness Compendium.
If the Cleveland Clinic’s aggressive methods on employee wellness stir a widespread debate, that’s a very good thing. The Center for Disease Control and Prevention projects that one of every three Americans will have diabetes by the year 2050. If that occurs, today’s healthcare cost concerns will seem like child’s play compared to what we’ll be facing later this century. Wellness has to become a national priority.
August 12, 2011
10:49 am
The Republican presidential candidates who participated in last night’s Iowa debate put on quite an interesting, as well as entertaining, show. With political analysts pointing out that this weekend’s Ames straw poll could winnow the field, the gloves came off as the eight candidates fought to maintain a critical mass of voter support.
Anyone who turned on the debate, though, to learn the candidates’ visions for healthcare in the United States would have come away disappointed.
We learned, to no one’s surprise, that the GOP presidential contenders have a steadfast dislike for the Affordable Care Act that President Obama signed into law last year. Most of the candidates also believe that the individual health insurance mandate contained in the ACA is unconstitutional.
It was also clear that, as long as former Massachusetts Governor Mitt Romney is the frontrunner, he will be criticized for what rival Tim Pawlenty calls “Obamneycare.”
But future GOP debates need to do more than reaffirm what the White House aspirants are against. There are indeed widespread concerns about the current health reform law, including questions over affordability, healthcare quality and whether an unprecedented expansion of Medicaid is the best approach for reducing the uninsured population. Those who would take Mr. Obama’s place need to spell out for us how they would do things differently. The questions they need to answer include:
• Do you support eliminating pre-existing conditions as a barrier to health coverage? And, if so, how do you achieve that without an individual mandate to ensure that consumers don’t wait until they’re sick or injured to purchase health insurance?
• How do you slow down the growth in healthcare costs without undermine healthcare quality, access or innovation?
• How do you address the question of Medicare sustainability?
• What are your answers to the projected workforce shortages in healthcare? How do we ensure enough medical professionals to treat a growing patient population?
• With the CDC calling for a huge escalation in the number of Americans with diabetes, how do you propose to address the rise in chronic disease cases that are driving healthcare costs?
With these questions and many others, there’s an important health policy debate to be had among the Republican presidential contenders. It just hasn’t happened yet.
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?
CATEGORIES: