
Be Healthy or Else: How Corporations Became Obsessed with Fitness Tracking - colinprince
https://backchannel.com/be-healthy-or-else-how-corporations-became-obsessed-with-fitness-tracking-b0c019faff8d#.wes4gmn96
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byuu
My employer/provider (Blue Cross) offered a $100 discount on insurance
premiums in return for me taking a vial of my own blood and mailing it off to
them for testing.

Although I am in (mostly) good physical shape, I found it beyond creepy and
refused to do it. But I worry about them increasing the discount in the
future. It'll be harder to say no when it's $1000, or $2000. And let's be
real: it's not a discount, it's a penalty for when you don't do what you're
told.

And given how my insurance doesn't even cover a 30-minute ER visit without
sending me a bill in the mail for $1700, it's hardly even worth having
insurance at all. At least at my age.

~~~
DoodleBuggy
>>> And given how my insurance doesn't even cover a 30-minute ER visit without
sending me a bill in the mail for $1700, it's hardly even worth having
insurance at all. At least at my age.

Until you show up uninsured at the same ER for the same visit and end up with
a $10,000 bill because you don't have insurance.

Whether it hits your deductible or not, insurance negotiates rates that are
easily 75% cheaper than what you'd pay without it.

~~~
byuu
> Until you show up uninsured at the same ER for the same visit and end up
> with a $10,000 bill because you don't have insurance.

That's the problem, though. If I can't afford it, then it doesn't matter
whether they charge me $1,700 I don't have, or $1,700,000 I don't have. Either
way, I'm not going to pay it, and it's going to end up going to collections
and dinging my credit.

Let's say the worst possible case happens and I get cancer. They don't treat
you for that in the ER, other than the bare minimum to keep you alive. But to
get those ungodly expensive $3,000 a dose drugs would require too much out of
pocket. I wouldn't be able to get them with or without insurance.

~~~
ams6110
If you come in with a cash payment offer you can likely get the same discount.
You do have to be willing to do a bit of negotiating however. Because nobody
without insurance is actually paying those $10,000 bills.

~~~
DoodleBuggy
That is false. You will typically get a 10% or 15% cash discount from the
hospital ticket price. Still easily 3x what an insurance company would
negotiate for you.

Some hospitals allow you to fill out extensive paperwork to apply to have
greater bill reductions, and you need to send in several years of tax returns,
bank statements, a personal financial statement, an explanation of your
situation and why you can't pay in full, etc. It's a grueling, paperwork
intensive, and invasive process.

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pliny
>If he chooses not to participate in the program, Abrams must pay an extra $50
per month toward his premium.

Is he paying $50 more for not participating, or getting a $50 discount for
participating?

If it's the latter (Anthem insurance doesn't change their premiums, but now
rewards people for using preventative medicine), then how could anyone object?
It really is a win-win, and people who don't want to participate are no worse
off.

But, if Anthem Insurance aren't trying to motivate healthier behavior, but
only trying to identify people who are already trying to become healthier (or
stay healthy) and lower their premiums in order to remain more competitive,
then it's the former. Workers are being penalized because P(Not trying to be
healthy | Doesn't participate in the wellness program) is greater than P(Not
trying to be healthy).

What this actually means: The trying-to-be-healthy population are no longer
subsidizing the not-trying-to-be-healthy population. I don't know if this is a
bad outcome, I remember hearing an interview with Cathy O'Neil (the author)
where she applies the same rhetoric and logic to loan approval and to criminal
sentencing, in both cases she ignores the fact that going from the status quo
(in this case, one where wellness programs exist) to her preferred reality (in
this case, one where wellness programs do not exist) tends to take a lot of
innocent people who are winners in the status quo (in this case, people who
try to stay healthy, and enjoy lower premiums) and makes them into losers
(since now they have to pay the same premiums as people who don't use
preventative medicine).

> Except, as it happens, this regimen already exists and it’s called
> humiliation and fat-shaming. Have someone tell you you’re overweight, or pay
> a major fine.

I'm not overweight, so maybe I don't have the right perspective on this, but
how terrible could "having a doctor tell you that you're overweight" be? Like,
the only context I can understand this quote is that "Have someone tell you
you're overweight" is some sort of grievous injury, and not just trivially
inconvenient.

~~~
DoodleBuggy
>>> but how terrible could "having a doctor tell you that you're overweight"
be?

How terrible would it be to have a doctor tell you to stop smoking? Or to stop
drinking? Or stop abusing drugs? Or to stop cutting yourself? It's all self
destructive behavior just like overeating.

Has our culture really become so sensitive that it's now no longer acceptable
for a doctor to tell you when you're being unhealthy and contributing to your
own demise????

~~~
DanBC
> How terrible would it be to have a doctor tell you to stop smoking? Or to
> stop drinking? Or stop abusing drugs? Or to stop cutting yourself? It's all
> self destructive behavior just like overeating.

It's not terrible, it's just pointless. Fat people know they're fat; people
who self harm know they self harm and they know it's not ideal.

Merely saying "stop doing that" does nothing ot help them stop.

~~~
edejong
This is why a doctor won't tell his patient: "stop FOO". Instead, they might
nudge him with information. Respecting the patients knowledge and struggle, a
doctor is understanding, supporting and able to connect with others who have
successfully "stopped FOO".

A good doctor understands that an eating disorder is part of a complex,
intertwined and difficult to understand network of causes and effects. Helping
the patient understand the complexity of the situation is often the first step
towards a permanent solution.

~~~
DanBC
Yes, I agree. Some people in this thread don't, and are saying that merely
telling someone that smoking is harmful is enough to make that person stop
smoking.

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ClearAsMud
If that certainly _is_ true, that's a multi-million dollar chaching for the
ADA and the ACLU. Also, if I was working for CVS I'd have my lawyer on that
like flies on rice for a number of slippery slope reasons. That fires me up a
ton, because if let's say the FitBit tracker they give you requires login,
they might do the setup for you and slap it on your wrist. Well, that
information contains monitoring and GPS coordinates and what is the policy
around that? What is the retention of data? What is the sharing of data
policy? I mean CVS case really raises an eyebrow for me.

"The national drugstore chain CVS announced in 2013 that it would require
employees to report their levels of body fat, blood sugar, blood pressure, and
cholesterol — or pay $600 a year."

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spectrum1234
In the long run these corporate solutions are what is needed. Why? Because
currently there is no financial incentive, in the short term, to stay healthy.
Health insurance costs continue to increase and adverse selection continually
makes this worse.

The bias in this article is disturbing because currently even the government
is doing nothing to incentive people financially in the short term in this
same way. Think 50 years down the line - if systems like this aren't in place
we are in serious trouble. There is no perfect solution but to blame companies
for tying health and its costs to short term costs is insane. This is a GOOD
THING. Wake up people!

This reminds me of a quote (paraphrasing). "The market is the worst form of
economic distribution, except for all others."

~~~
analog31
There's already a health incentive to stay healthy, by definition. If people
won't obey a health incentive, why will they obey a financial incentive?

And there's already a financial incentive as well: Discrimination provides a
financial advantage to people who appear more healthy (younger, thinner,
taller).

~~~
nharada
Staying healthy is a really long term goal. You need to do it every day but
there's no immediate penalty for not being healthy on a day to day basis.
Penalizing someone financially is much more real and tangible than "that pizza
you ate today is contributing very slightly to your degrading health"

~~~
analog31
That sounds plausible, but on the other hand, it also sounds plausible that
the immediate discomfort of dieting for most people would outweigh the
immediate financial incentive.

An additional plausible explanation, that always has to be considered until
it's eliminated, is that wellness reward programs don't work at all, but tap
into the psychology of the HR managers who buy that kind of stuff.

I was only thinking in terms of a simplistic "homo economicus" model, in which
a worker acts rationally in their own best interest. If we abandon that model,
I'm not sure we have a useful alternative.

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crazygringo
> _Those who don’t reach the targets in three categories have to pay an extra
> $1,000 a year toward their health insurance._

It sounds a lot less sinister if you rephrase it:

 _And those who reach targets in three categories get an extra $1,000 on their
paycheck, that comes from the discount on their health insurance._

This kind of data should not be known/tracked by your employer ever, for
reasons of privacy. That's totally different from your health plan knowing,
however.

The deep question here, regarding all health insurance (including national
schemes), is -- to what extent should you be expected to subsidize other
people's intentionally unhealthy life choices? To what extent should people
who make these unhealthy choices be forced to pay more for them? If I get
diabetes because I drank 20 cokes a day...

But it gets even harder, because who defines healthy? The long-term effects of
so many activities is so unclear, or under so much debate -- just like sugar,
for example.

~~~
Asooka
I have a somewhat more practical objection - when you reduce their pay, how
are these people supposed to get healthy again? Achieving healthy status seems
more costly than maintaining it, but with this system, if you fall behind,
your resources are further reduced on top of you being physically worse,
making it even harder to get back to being healthy. It's like Mario Kart
without blue shells.

~~~
brianwawok
Except it's not a cut for people who don't follow. It's a bonus for those that
do. Anyone can get the bonus, just do the dance.

~~~
izacus
Huh? Surely you understand that there's no difference between calling
something a "cut" or a "bonus" when the result is the same?

~~~
brianwawok
Perception my friend. Perception is everything.

We give a tax cut to people with kids to encourage families in the US. How
would people react if we changed it to a no-kid penalty paid by all people
without children? Same thing right? But we would react very different to it.

------
petre
They took a good idea (welness programs) and made a creepy dystopian thing out
of it (biometric tracking for penalizing you on health insurance). That's what
_Weapons of Math Destruction_ is all about: tracking, data mining/collection,
algorithms that discriminate people based on the data collected. This article
is essentialy a advert for the book. I've read some of it in a library.

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syntheticnature
One of the big problem with Wellness programs is the same problem of measuring
programmer productivity by tracking LOC -- it's a set of numbers that are only
a proxy for the real thing. I look good on some numbers typically used and not
so good on others, but I've only needed preventative maintenance for a while.

Of course, what the insurance companies really care about is their cost, not
your actual health, which is why the folks with the discounted plans wound up
using the insurance more at a past employer -- strong encouragement to
exercise more caused more exercise-induced injuries, particularly among a set
of mountain bikers that became competitive once the company started logging
their mileage as part of the "Wellness" program ... and they started logging
broken bones!

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vermontdevil
My employer gives me and my wife $50 total monthly deduction from our
insurance payment for not smoking.

Of course if they find out you got sick from smoking, your coverage will be
denied.

My worry is what if they try to use this as a way to avoid covering
catastrophically expensive illness where the underlying cause might be
ambiguous and subject to interpretation.

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jimmyswimmy
My company requires an annual health assessment be completed in order to avoid
a higher insurance rate. There is no requirement that the data entered in the
assessment be truthful. It seems like applying such a requirement would be
difficult as all the data are self reported, therefore difficult to verify
much of it. I have little objection to this approach.

On the other hand the "livewell" points scheme seems annoying. I wonder
whether employers consider the added cost. Most employees will complete such
extra work-imposed requirements while at work instead of actually working.
Suppose this costs four hours per month, that could easily work out to 5k/yr
in most tech jobs. That's probably an underestimate. How does that compare to
the reduced cost of insurance coverage?

~~~
tdb7893
I think healthy employees have benefits besides just insurance benefits. Being
healthy has a lot of benefits in general (less sick days and in my experience
better focus and mood) and people should be taking some short breaks during
the day regardless. I think of these programs actually affect employee health
then they are worth a cost

~~~
jimmyswimmy
> I think of these programs actually affect employee health then they are
> worth a cost

That may be so. But there are multiple costs: lost work due to completing
these mandates, potential indignation over privacy concerns resulting in
excess turnover, and other second order effects. My experience with the
financial management teams at multiple companies leads me to believe that none
of these, beyond the first order cost reduction ("ooh, lower insurance
costs!") are being considered.

It would not be that time consuming to complete an analysis of this. Depends
strongly on your labour costs. But it should be considered. One could imagine
this increasing the overhead of most large companies by a few percent,
depending on how much the insurance reduction is.

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zebraflask
I think the sane approach is to provide voluntary incentives, without
excessive tracking or "punishments" for not hitting arbitrary targets. My
company has quite a variety of informal health-related perks and programs (gym
discounts, on-site yoga, fun runs, etc.) which many people seem to enjoy using
or participating in. There's no coercion, either overt or implicit, which I
think is the key to success with these kinds of lifestyle issues.

~~~
spectrum1234
This is voluntary.

~~~
zebraflask
I think I'm getting at removing the "or else" part of the scenario.

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nradov
Those interested in the legal basis for medical premium insurance discounts
based on wellness programs should read Incentives for Nondiscriminatory
Wellness Programs in Group Health Plans. It has all the details on what is and
isn't legally allowed.

[https://www.federalregister.gov/documents/2013/06/03/2013-12...](https://www.federalregister.gov/documents/2013/06/03/2013-12916/incentives-
for-nondiscriminatory-wellness-programs-in-group-health-plans)

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pluma
As a European: WTF. This is a perfect example of what is wrong with the US
healthcare system and employment-based health insurance.

The privacy headache of having the employer handle medical information alone
would make this impossible (in Germany at least).

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jmclnx
how about going back to a real 40 hour work week so we have time keep in shape

~~~
drewrv
Or we could decouple access to healthcare from employment.

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samfisher83
Companies need to control healthcare costs which are quite high in the US.
Things like screening etc. theoretically should help by catching diseases
earlier starting prevention earlier.

~~~
mamon
The original sin here is that healthcare insurance is managed by a company
instead of the government. That gives an employer too much power over their
employees.

In Europe healthcare costs are just another tax, which rate is set by
goverment and your employer is just responsible for substracting that from
your salary and transfering to government's bank account, but has no say about
how much you should pay.The plus side is that your employer simply does not
give a damn about your lifestyle choices.

~~~
chrisseaton
> The plus side is that your employer simply does not give a damn about your
> lifestyle choices.

Employers still want you to be healthy because they don't want you taking days
off work sick. In-service death benefits from heart attacks or whatever could
be hundreds of thousands of euros and they still pay them even if you have a
national health service. It's probably cheaper to pay for a gym than sick days
and in-death benefits.

~~~
mamon
You are partialy right, some employers will still care about your well being,
but the point is that

1\. Not all employers will care, and that fact alone gives you some choice.

2\. Even employers that do care can only encourage you to live healty
lifestyle but cannot punish you for not following their recomendations
(financialy or otherwise)

------
actuary
If the article were instead devoted to exploring the application of similar
programs in a different context, perhaps it would have been named "Drive Safe
or Else: How Car Insurance Companies Became Obsessed with Tracking Your
Speeding Tickets".

There are clear benefits to charging insureds in proportion to risk,
especially controllable risk. But of course these benefits need to be weighed
against potential negative impacts. There's some discussion here about how to
strike the right balance. It may be comforting to learn that actuaries, who
design these risk classification programs, and regulators, who monitor and
approve them, aren't just making this up as they go along. We're guided by
principles, a basic summary of which [0] covers some of the topics discussed
in this thread. Of course this only scratches the surface.

[0] [http://actuarialstandardsboard.org/wp-
content/uploads/2014/0...](http://actuarialstandardsboard.org/wp-
content/uploads/2014/07/riskclassificationSOP.pdf)

