Does the Safeway Amendment address workplace wellness in a financially responsible manner?

As the debate for healthcare reform continues inside the beltway, on the airwaves, and around many a dinner table and water cooler, how can we — a nation known for ingenuity and entrepreneurship — deliver quality care for a reasonable price? Former House Speaker Newt Gingrich, in his book Saving Lives, Saving Money, is but one voice suggesting that America could do much better. Princeton economist Professor Ute Reinhardt has also condemned our current system for wasting money, doing little to create wellness and all-too-frequently serving vested interests rather than patients’ health.

Business journals and newspapers, including The Wall Street Journal, have charted the impact of America’s rising healthcare costs on the nation’s industrial competitiveness. In his 1986 book America’s Health Care Revolution: Who Lives? Who Dies? former Secretary of Health, Education and Welfare Joseph Califano Jr., revealed that Chrysler was spending more on healthcare (Califano called it “sick care”) than on steel for its automobiles. Whole Foods CEO John Mackey and Safeway CEO Steve Burd have published editorials in The Wall Street Journal about their commitment to a financially responsible approach to employees’ health. Given the $1.7 trillion deficit, many of us wonder if the concept of financially responsible healthcare reform resonates with our elected officials.

The fall 2009 issue of The American Acupuncturist included an article, “Evaluation in Acupuncture: Past and Future,” by a team of authors led by New York acupuncturist Michael Jabbour, LAc, MS. Jabbour had examined the literature for all studies of acupuncture that focus on costs. A key thrust of his article was to give a monetary value to "quality of life years" gained by the use of acupuncture. The authors, who noted the importance of including "indirect costs and intangible costs" in economic studies, concluded that "acupuncture has the capacity to offer cost-effective treatment, even when compared to conventional medicine”.

Economist and researcher Patricia Herman, ND, MS, Ph.D., published “Herman's Systematic Review Yields Top 9 Therapies/21 Conditions with High Quality Evidence of Cost Savings from CAM” in the August 27, 2009, issue of The Integrator. Herman noted that the most intriguing finding by the studies she has so far been able to evaluate is that "over 50% show cost savings." She underscores that "this is beyond cost-effectiveness to cost-savings," adding that "this is not likely just an artifact of publication bias because there is no disincentive for publishing something as cost-effective vs. cost saving." Herman notes that this is particularly interesting given "the typical conventional point of view that CAM increases cost."

Both the Safeway amendment from the Senate Finance Committee and HR 3200 (America’s Affordable Health Choices Act) address workplace wellness, including incentives for participation in voluntary wellness programs. Existing HIPAA legislation permits insurance premium discounts of up to 20 percent when an individual meets wellness program criteria. For example, the current Safeway wellness program requires employees to meet healthy weight, blood pressure, and cholesterol benchmarks and requires that they not smoke. If the individual fails to meet these criteria, premiums may be raised by 20 percent. The Safeway amendment increases the discount limits to between 30 percent and 50 percent. A group of 65 industry organizations have recently written a letter to Congress stating, “We believe that allowing employers to vary premiums by up to 50 percent of the total cost of employee coverage could lead to discriminatory practices and make health coverage unaffordable for those who need it the most.” However, the current model, which leads to a mentality of “Bill my insurance,” has done little to encourage individuals covered by employer-paid plans to control their own healthcare costs. It is true that the insurance discount must be carefully managed to avoid employer violation of employee privacy. Employers should not have access to an employee’s blood pressure numbers. But rewarding healthy lifestyle choices can be done without invading privacy. And of course in the long run people shouldn’t have to look to their employer as the only source of tax favored health insurance.

According to economist Dr. Ute Reinhardt, the wage controls during World War II, which inspired the current system of employer-paid health insurance, with its tax benefits solely for businesses, is unsustainable. Individual responsibility and freedom of choice have driven America’s use of integrative medicine. More importantly, integrative medicine is effective and costs less than disease care. This approach also protects the privacy of medical records.