A recent NPR poll revealed some interesting results about handling the rapidly growing costs of health care. The poll of 3,000 adults was conducted in September via telephone by NPR and Thomson Reuters Health and showed support for a rewards and penalty system for health behaviors.
For example, 59% of the respondents believed that smokers should pay more for healthcare while only 31% favored penalizing those who are overweight or obese. Regarding smoking behaviors, some employers agree with the poll. When it released it poll results, NPR also reported that Wal-Mart, the nation’s largest private employer, will start charging between $260 and $2,340 more annually for health insurance for those who smoke. On the other hand, they will also offer free smoking cessation assistance to any of their employees. These policies take effect in January.
Regarding obesity, it may be of importance to mention that 69% (just over one-third of the poll group) did not favor a penalty. Interestingly, that number represents about the same percentage of Americans who are considered overweight or obese.
There was resounding support for insurance breaks or rewards rather than penalties when it comes to health behaviors. NPR found that 85 of the people felt that a rewards system is better than a penalty system to improve health. For years, companies have been promoting health by offering financial incentives for healthy behaviors. According to a 2007 study by the National Business Group on Health and Watson Wyatt found that 355 large employers across the nation provide such incentives, revealing that the action has resulted in lower costs for sick leave, long-term disability, short-term disability, and general health coverage. It wasn’t until this year that companies are now stepping up to not only reward healthy behaviors but penalize poor healthy choices such as smoking.
My opinion of the poll results is rather mixed. If companies have been offering rewards for healthy behaviors for years, then why is our nation still suffering from an obesity epidemic that keeps growing? Why do we have a significant number of smokers? We need to question whether the rewards are enticing enough to promote positive behaviors or reverse poor health choices. It begs the question of whether we, as human beings, respond to positive reinforcement for health-related behaviors. According to Dr. Alex Lickerman from the University of Chicago, positive reinforcement is definitely the best approach if done correctly. According to Lickerman, rewards for positive health behaviors must be large enough and have strong perceived importance, and also should be presented immediately following the desired behaviors to promote long-term health.
If positive reinforcement is the best practice, I can’t help but wonder if the companies who are providing insurance breaks and other financial rewards are following Lickerman’s advice for implementing a reward system. I can’t help but think that they are not. Perhaps the incentive isn’t enough, perhaps it’s not perceived as an important reward, or perhaps it is not presented in a timely fashion. If all these factors were happening, wouldn’t we be seeing a reversal of obesity rates, or a reduction of smoking prevalence?
While I don’t know what the solution is, I believe that a combination of both would be the optimal action. I am fully supportive of penalizing poor health choices. We basically already do that with things such as the cigarette tax and alcohol tax. While these haven’t eliminated the problem, studies have shown that some penalties have certainly helped reduce tobacco and alcohol use. We have also penalized those with poor driving habits such as ticketing those for not wearing a seatbelt, or for speeding. Again, the problem is not gone, but motor vehicle deaths have dropped as a result of increased seatbelt use and speed limits.
Overall, I believe people should pay or are already paying the price for their health choices: both positive and negative. If you want to smoke, you should pay the price for that behavior. You will have long-term health effects (which are preventable) such as emphysema, lung cancer, or COPD that will cost the country’s health care system more money. If you subscribe to overeating unhealthy eating behaviors, the health care costs will also be exorbitant over your lifespan as you might suffer diabetes, heart disease, and various cancers that are preventable. Again, I support initiatives of increased insurance rates for such behaviors. If you subscribe to regular exercise to maintain your health, I again have no problem with the cost. Those people are already sinking money into their health care in the form of fitness center memberships, personal trainers, and exercise equipment among other costs.
While I was not among those questioned in the NPR poll, I would have been among those who supported penalties for health behaviors. I have no qualms with insurance companies or employers hiking their rates for people who subscribe to poor health choices. But, I also support positive reinforcement for positive behaviors. I am in favor of companies fully paying for smoking cessation efforts, drug/alcohol rehabilitation, and weight loss clinics. I am also in favor of companies offering discount or free memberships to fitness clubs to maintain their employees’ health. Many companies are already doing both, and I applaud their efforts.
I’m interested in what Tribune readers have to say about this? Are you in favor of financial penalties for poor health behaviors? Do you support positive reinforcement? Please let me know your opinion on my blog at www.crawfordcountyhealth.blogspot.com. It’s your choice if you wish to leave your name, but I’d love to hear your opinion.
References:
Hensley, S. (2011). Insurance penalties for smokers draws wide support. Retrieved November 8, 2011 from http://www.npr.org/blogs/health/2011/11/03/141984867/insurance-penalties-for-smokers-draw-wide-support?ft=1&f=103537970.
Lickerman, A. (2011). Positive reinforcement can motivate preventive behaviors. Retrieved November 8, 2011 from http://www.kevinmd.com/blog/2010/08/positive-reinforcement-motivate-preventive-behaviors.html.
Selko, A. (2008). Employers offering financial rewards for healthy behaviors. Retrieved November 8, 2011 from http://www.industryweek.com/articles/employers_offering_financial_rewards_for_healthy_behavior_15505.aspx.
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