Even as American corporations twist themselves into pretzel shapes to persuade shareholders of their devotion to maximizing profits, why are they throwing an estimated $8 billion annually at workplace wellness programs that, according to a growing body of evidence, don’t work?
The zeal for wellness programs — which aim to get workers to exercise, lose weight, avoid smoking, drink in moderation, and stress less — is just one more flashing red indicator of political risks as companies grow more desperate to restrain skyrocketing health care costs.
Due to their post-World War II decisions to compete for workers in a fast rebuilding U.S. economy, companies long have been the go-to source for Americans’ health insurance: In exchange for a quarter of trillion dollars in federal tax subsidies, employers provide more than half of nonelderly U.S. workers — 152 million of us — workplace health coverage.
But as health care and coverage costs have headed skyward, companies have sought to offload on to workers a greater share of medical and wellbeing expenses with ever-higher premiums and rising deductibles — out of pocket costs they must fork over before they can begin to benefit from their medical insurance. They’re hovering around $1,500 on average. With premiums and deductibles hitting nose-bleed levels, too many Americans effectively are underinsured or even almost uninsured, the Commonwealth Fund reported recently. This means they don’t get the medical services they need, or they forego care because of its cost. Delays in diagnosis and treatment due to high-deductible health coverage is common and harmful, notably to cancer patients, a recent study found.
At the same time, companies have barraged their workers with workplace wellness initiatives, offering them both carrots (incentives) and sticks (penalties) for participating in the programs.
Previous research had shown that the programs aren’t effective. Now a large, randomized clinical trial, with results published in the influential Journal of the American Medical Association, has underscored the initiatives’ limits. As Modern Healthcare reported of the latest study, involving tens of thousands of workers at a nationwide big box retailer:
Researchers found that workplace wellness participants exercise more, actively manage their weight and have other healthier behaviors than their peers outside of the programs. However, they don’t have lower body mass index, blood pressure or cholesterol … The study also found the programs did not result in a significant reduction in healthcare spending or utilization of health care services.
This research is harder to attack than previous workplace wellness studies. The latest work was not observational. It involved randomly assigning some workers to a program, while others were not, meaning they acted as a control group. It is true that participants self-reported before and after data on their program participation, medical test results (blood pressure and cholesterol), and behaviors (diet and exercise). They also got relatively modest incentives or rewards for being in their wellness program.
Employers, of course, have flogged wellness programs in relentless fashion, offering large incentives for participation, including reductions in health insurance costs. But some companies also have tried to extract increasing and intrusive amounts of information on their workers’ lives and medical needs and conditions. AARP, the nations’ largest advocacy group for Americans 50 and older, battled corporate America and the federal Equal Employment Opportunity Commission over wellness programs. AARP called too many of them biased, intrusive, and coercive—and a federal judge agreed, rolling back EEOC rules favoring companies and their attempts to get workers in wellness programs.
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become a bigger ordeal as the cost, complexity, and uncertainty of therapies and prescription medications have skyrocketed, with too many expensive drugs also proving to be dangerous and even lethal. It’s a great idea, from my experience, for us all to try to stay healthy and out of the clutches and risks of medical treatment. Yet more research has shown that exercise, eating well, keeping excess weight off, not smoking, drinking with care, and stressing less can be beneficial in avoiding major killers like cancer. But rather than trying to push wellness with Big Brother programs at work that don’t work, maybe companies could use a few of their billions to help their workers more by reducing the premiums and deductibles for job-obtained health insurance?
The latest research doubting workplace wellness programs appeared almost at the same time as did new data on employer health coverage, including that it forces poorer and sicker workers to pay a bigger chunk of their earnings than higher-paid colleagues must, and that companies and employees alike struggle with job-related plans because of churn: They change insurers, premiums, and benefits so often and with such extremes — and not only if folks change companies but also if they stay put.
How long can corporations battle for their bottom lines, both by hurting their own people’s finances and by wrangling with the administration of complex, expensive health plans? Walmart and other employers are pouring lots of time and resources, not always with optimal outcomes, into initiatives beyond wellness programs to cut health care costs. Much attention is being paid to Haven, a new venture by Amazon, JP Morgan, and Berkshire Hathaway, to address this giant issue. But if the system becomes yet more dysfunctional and teeters further, will policy experts and politicians be any more helpful than they have been with their decade of clashes over the Affordable Care Act, aka Obamacare?
President Trump keeps asserting in counter factual, almost magical fashion that his Republicans not only will find a way through the vexing problems that patients and their families confront, the GOP, he says, will be known as the health care party. But remember: It’s the Trump Administration that is in federal courts now, advocating for the demise of Obamacare without explaining how tens of millions of Americans would be insured if the ACA vanishes. It’s House GOP leaders who are telling Big Pharma to hold up a middle digit to investigations (yes, they’re Democrat led now) of sky-high prescription drug prices. It’s GOP lawmakers in state capitols across the country who, in the midst of troubling infectious disease outbreaks across the land, are resisting efforts to tighten up exemptions from requirements that youngsters get vaccinated.
These are data points voters may need to keep in mind as the 2020 campaign ramps up. Medical care and health care policy aren’t easy or simple. But we’re all a heartbeat away from catastrophic illness or injury. Do we want to face that crushing, bankrupting crisis on our own or with collective help and compassion? We have choices ahead.