With a few bumps along the way, we're moving toward a better healthcare system for everyone. As we move toward universal health care, we've become increasingly conscious of the terrible financial cost of treating the ill and the unfit. To address that cost, we need to train ourselves to live more healthfully. We can lower the national cost of health care most effectively by becoming healthier.
Darren Wilcox, a Washington healthcare lobbyist and executive director of the Coalition to Advance Healthcare Reform has suggested that we could put a large dent in our healthcare costs by creating programs that incentivize healthful behavior. It's not a new idea, and some employers already tie their medical contributions to employee behavior, yet it's hard to see why it isn't an integral part of our whole healthcare system. He pointed out a few years ago that more than half of all healthcare costs are caused by an individual's choices -- whether or not to exercise, lose weight, quit smoking, and so on. Most healthcare expenditures arise from chronic conditions that respond to lifestyle changes: diabetes, hypertension and heart conditions. "By simply lowering obesity rates, for example, we could avoid $60 billion in annual medical costs and gain back $254 billion in productivity."
We need to embrace this kind of thinking. What if health insurers offered lower rates to those who wore tracking devices, like FitBit, to monitor calories burned during a day, weight gained or lost, and hours of sleep per night -- or discovered ways to delve even deeper into healthful behaviors and record them? And even lower rates for those who were exceptionally active and kept their weight at an ideal level? With wireless/Bluetooth technology it wouldn't be hard to sync something like FitBit to a wireless bathroom scale, for a daily record of weight, and for the diabetic, a more advanced device could track variations in blood sugar.
There are limits to how much data a device could gather, and how accurate it would be, but much of this could be done now with existing technology. The point is to encourage and reward preventive care and healthful behavior, not reimburse for the diseases that arise when people are careless with their bodies.
Various organizations around the country already link how much they will pay for health coverage to measures of healthful behavior: workers who don't smoke, aren't overweight, and have acceptable cholesterol and blood pressure levels will pay less in deductibles. Some employees consider this an invasion of privacy, but companies can easily make these tests optional -- only those willing to prove their level of fitness could be given the opportunity to lower their insurance deductible or increase how much an employer contributes to a healthcare expense account.
USA Today has reported:
"Of the employers who offer such programs, about one-third offer financial incentives to those who undergo specific medical tests, according to an Aon Hewitt survey. And 5% of those tie the financial rewards or penalties to meeting specific medical-based standards. The survey also found an expansion of such tests is on the horizon: 57% of employers said they planned to add incentives for spouses and dependents in the next three to five years. "A lot of costs come from spouses, but only 29 percent had incentives for spouses," says Cathy Tripp, a senior vice president at Aon.
Some of the more familiar of the companies that have adopted these measures are United Healthcare, Hertz, Pitney Bowes and Gannett, owner of USA TODAY. More employers were expected to adopt them this year, as the health law began to allow for offer larger incentives or penalties.
Evidence is hard to come by about how well these programs work in lowering healthcare expenditures or improving health, mostly because there hasn't really been enough time for longitudinal studies. But most agree that they are effective in helping people quit smoking.
Anything that focuses on prevention rather than just treatment should be embraced whole-heartedly by any organization that offers healthcare coverage. Even better than providing everyone access to treatment for disease is to create a path for people to become so healthy they will need it less and less. The idea is simply and basic. Let's start acting responsibly for ourselves and increasingly for the larger common good.