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What's the End Game for the Wellness Movement?

John Commins, for HealthLeaders Media, November 28, 2011

We need a new holiday to commiserate our annual health insurance renewals. We could call it National Premium Supplication Day. Hallmark could issue a special greeting card:

"On Premium Supplication Day,
We Brace Ourselves for More to Pay.
We See the Co-pay Costs Uptick,
and Pray To God We Don't Get Sick."

Every year about this time, people across the nation who are lucky enough to have jobs -- and lucky enough to have healthcare coverage through their jobs – head to HR to find out how much more of their paycheck will go toward premiums, deductibles and co-pays, and what benefits they'll lose.

For many workers, those insurance hikes will eat most -- if not all -- of the relatively small annual raise they may have received. The high deductibles will make access to preventative care unaffordable for many.     

Companies aren't to blame. They try their best to make healthcare affordable to their employees – often subsidizing the cost to a great extent. When it comes to controlling healthcare costs, most companies are as powerless as their employees.  Healthcare is expensive, and there is nothing to suggest that it will get any cheaper.

Mercer this month released a study which shows that the national average cost of healthcare benefits was about $10,146 per employee, up 6.1% from the previous year. The Mercer estimate is conservative. The Kaiser Family Foundation/Health Research & Educational Trust 2011 Employer Health Benefits Survey reported in September that the average annual premium for family coverage increased by 9% to $15,073 in 2011. Since 2001, KFF/HRET noted, family premiums have increased 113%, compared with 34% for workers' wages and 27% for inflation. 

Whatever cost growth estimates you pick, they are unsustainable. At some point, perhaps sooner than later, businesses will determine they can't afford to provide healthcare coverage. Some surveys have suggested that many businesses have already made the decision to drop their coverage in 2014 when provisions in the Affordable Care Act take effect, particularly the individual mandate.

It would be no small irony if our for-profit healthcare system prices itself out of existence and ushers in a government-sponsored single-payer system. We are trending that way as "cost containment" in our healthcare system has come to mean passing more of the financial burden onto the healthcare consumer.  

It is under these circumstances that we are seeing a surge in the wellness movement – the idea that employees should take greater responsibility for their health or pay the consequences.

At face value it seems reasonable. Why should the rest of us pay for your lousy lifestyle choices? However, the wellness movement also has huge potential for abuse and discrimination. It also raises troubling questions about who gets thrown overboard, and where we draw the line on employer intrusions into our personal lives. 

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