Agree with the concept of an "incentive" vs a penalty, but it's clear that individuals MUST take a greater role in their own health. The statistics in regards to healthy eating an even minimal exercise are powerful in terms of a positive impact on an individual's health.

It's gotten to the point where folks aren't doing it themselves, and with employers picking up the tab for the poor choices of individuals, this was bound to be the next step.

We've got a free White Paper on all the statistics around wellness issues on our website if you're interested (www.USCorporateWellness.com -- look at the Wellness Quotient tab)

Will it hurt retention of staff who are smokers or are overweight? I'll bet that is what they are hoping for.

Obesity and smoking independently predict employee absenteeism. Absenteeism is incredibly disruptive and lowers moralle for all. You cannot sack people for calling in sick, but you can find ways to progressively make continued employment less attractive.

A much more serious question comes to mind if one reads the whole article - that of mandating medical intervention for healthy people for, often negligible, risk reduction and depriving people from their right to make informed medical choices. Because Clarion plan is not all about smoking and obesity.

Not only Clarion plan as described in most articles proposes to fine people for smoking/obesity, it also fines people for blood pressure over 140/90 or LDL over 130. But genes are responsible for many of these metrics. Should the decision if to medicate or not medicate people be done in doctor's office based on careful evaluation of individual circumstances and history or should it be determined by bureacrats in charge of such plans? Is the decision to prescribe drugs is as simple as "LDL is above 130"? Shall the individual decision to take or not take medication be dictated by salary? What if a person has serious side effects from these drugs? Should such a person be penalized? Finally, are all such medical intervention even cost-saving? In some cases number needed to treat is pretty high.

An example. I am slim (BMI - 22), athletic, non-smoking woman with no diabetes and 10-year heart attack risk of under 1% according to Framigham calculator. Yet my LDL is over 130 because of my genes - and that with all heatlhy choices for food. My HDL is high, but there is no mention in Clarion plan about HDL. So most doctors, at least those who practice evidence-based medicine, wouldn't consider putting me on statins (and incidentally, I haven't seen compelling evidence for statins for primary prevention in women but this is another subject).

If I had been working for Clarion, I'd be told to reduce my LDL. Since there is not much weight I can loose before becoming anorexic, and since I already eat all the right foods and exercise there is no way I can reduce it without drugs. So what Clarion plan would essentially tell me is "take statins or earn less". Is this legal? Is this ethical? Is medicating people like me likely to save money?

The savings for primary prevention of chronic deseases are not as clear. Obese people that exerciese may loose weight, but they may also have injuries. People whose risk of some deseases are high may die earlier and end up consting less. Some Clarion employee may decide to take a few pills before cholesterol tests just to "meet the numbers". Some employees may go on a crash diet but fail to maintain long-term weight loss, again costing more money at the end. A lot of people will be put on drugs. Given that the number needed to treat for many primary prevention measures is pretty high, this type of intervention would end up costing more money that they would save.
Also, runners cost more too, they have more injuries. So why not penalize everyone who is statistically more likely to cost more?

But interferance with people's right to refuse medication is what really concerns me most.

$5 penalty for smoking? Come on. Smokers are paying, what, $50 a carton for their cigs now. If that cost doesn't deter them, I don't know what will.

Come on, who thought this one up? So what's next, are hospitals going to dock staff for bringing food into work that is too high in saturated fat? Good luck trying to keep your nursing staff from finding work somewhere else.

Will it hurt retention of staff who are smokers or are overweight? I'll bet that is what they are hoping for.

Obesity and smoking independently predict employee absenteeism. Absenteeism is incredibly disruptive and lowers moralle for all. You cannot sack people for calling in sick, but you can find ways to progressively make continued employment less attractive.

I smoke and I've called in sick once in 25 years - can you beat that? My coworker is "obese" yet very fit and has called in sick zero times in 12 years. Should we be forced out of our jobs thanks to your questionable stats?

People are not statistics.

It's gotten to the point where folks aren't doing it themselves, and with employers picking up the tab for the poor choices of individuals, this was bound to be the next step.

Picking up the tab? More like picking my pocket to help pay to force folks to use their services. My out of pocket premium increases have exceeded my annual raise for 6 straight years for less and less coverage and now they want to mandate that I utilize their idea of healthy? Reaching ideal targets of surrogate markers doesn't equal healthy anymore than being statistically "at risk" makes one ill.

My immediate reaction was something like, "How utterly ridiculous!" Your BMI bears little correlation with your rate of absenteeism, and has less to do with your health than the media would have you believe. I would take offense to this as a form of discrimination; not everyone with a high BMI is a fat slob who makes poor choices, which is what this insurance penalty would seem to imply. Smokers, however, are in a different class. Smoking HAS been shown to cost insurance companies a lot of excess money, and cigarettes are not a biological requirement like food is. So lumping these two together and penalizing both is presumptuous and inappropriate. Workers are not being paid for what they do off the clock, and for the most part lifestyle choices are set long before a person becomes employed. So I would say "keep your hands out of my paycheck, please!" and suggest they find less punitive ways to cut costs.

This appears to be enforcing health by punishment. I think child rearing speciaists vetoed that kind of behavior years ago.

How about giving a reward e.g.

Lowering contribution to health insurance premium, a prepaid master card for uncovered alternative medicine

or offering to cover acupuncture or hypnosis used to give up smoking.

This is definitely the enforcement method, so opposite the concept of prevention and incentives to strive for good health.

Interesting how this one entry sparked so much valuable response.

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