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Should Unhealthy Workers Pay Penalties?

Clarian Health Partners, a hospital chain based in Indiana, in 2009 will start charging workers who smoke, are overweight, or have high blood pressure, blood sugar or cholesterol. (See stories in BusinessWeek and the Chicago Tribune, and the Today Show blog).

The plan, which could charge workers up to $780 a year, has drawn fire from opponents. According to the Chicago Tribune story:

Lewis Maltby, president of the National Workrights Institute, a Princeton, N.J.-based employee rights group, called the trend "a very dangerous road that could lead to employers controlling everything we do in our private lives."

The BusinessWeek story says other employers are interested in Clarian's approach, quoting one source who says it might be a trend.

But is Clarian doing the right thing?

Taking Responsibility

Clarian's approach is wrongheaded. It underscores the sorry state of U.S. health care, which the next president, along with Congress and industry, must fix. But charging someone who's overweight isn't going to repair our broken system; it's only going to irritate working men and women and likely lead to pricey legal battles. It's also unfair to those who have medical problems beyond their control that may lead to obesity or other conditions.

Though some say corporate incentives for employee health only go so far, they're a better tack to take, at least until our political and corporate leaders get their act together. 

That said, America does need to get healthier, and the seed of change must be planted in families. Statistics about obese children are maddening -- we should make sure they don't get addicted to junk food, fast food and soft drinks. Exercise, too, ought to be a theme from the very beginning. We've become such a car culture that we'd rather drive to the corner store than walk. The conveniences of our great nation have, I'm afraid, gone into overdrive when it comes to our waistlines.

And we should take a cue from our European friends, who enjoy top-quality produce, meat and poultry and sensible portions. The old adage says you are what you eat, and if you're eating too much of a bad thing, well ...

Clarian's Plan

According to the BusinessWeek story, Clarian will:

fine employees $10 per paycheck if their body mass index (BMI, a ratio of height to weight that measures body fat) is over 30. If their cholesterol, blood pressure, and glucose levels are too high, they'll be charged $5 for each standard they don't meet. Ditto if they smoke: Starting next year, they'll be charged another $5 in each check. ...

But some employment lawyers and wellness program administrators believe Clarian's approach may not be so unusual in coming years. They see employers, already overwhelmed by rising health-care costs, getting more aggressive in mandating changes in employee behavior. Garry Mathiason, a senior partner at employment law firm Littler Mendelson, says more than 300 companies have requested its assistance on mandatory wellness initiatives since it released a study on the topic in April. "In reality, you only get a certain amount of participation with incentive and encouragement," he says. ...

What's more likely for employers who start measuring health results is that they will provide carrots. In July, UnitedHealthcare began offering a new plan targeted at small businesses called Vital Measures, which combines a high-deductible insurance plan with a supplemental plan that provides discounts for healthy outcomes. Members who choose to participate will receive $500 discounts toward their deductible for each cholesterol, blood pressure, and BMI level they meet, along with refraining from tobacco use or taking a health risk assessment.

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