Monday, May 23, 2016

Health Care in America - What you better know! Insights by Dr. Jon Robison


Dr. Jon and sidekick Lady

Dr. Jon Robison at

What Do the EEOC, Wellness Industry, Urban Dictionary, Humpty Dumpty and George Orwell Have In Common?

                 "A word means what I choose it to mean—neither more or less.”                                                                                                                            --Humpty Dumpty
Written Together With Al Lewis 
The wellness industry is rejoicing at the EEOC’s final rulings on workplace wellness programs. The results boil down to this. The programs can require participation, compel employees to hand over medical information from screenings and health risk assessments (and even their DNA) and punish them if they don’t comply, as long as the programs are voluntary.

If you are having trouble reconciling the words require, compel and punish with voluntary, so were we. In fact, befuddled by the EEOC / Wellness Industry’s use of the term “voluntary” we went to the source seeking answers.  Google helped us to look more deeply into definitions of “voluntary” to make sure we weren’t missing something. Here are a couple we found:
               -- done, made, brought about, undertaken, etc., of one's own accord or by free choice
·                   Merriam Webster -- done or given because you want to and not because you are forced to: done or given by choice

No less befuddled, we were determined not to give up! We thought: “This definition has got to come from somewhere; they cannot just have made it up. Perhaps a more updated, hip source is needed here. What about the Urban Dictionary?” And sure enough, there we found the answer:

Urban dictionary -- do it or you will lose your job

Now we were getting somewhere. In the eyes of the wellness industry and now also apparently the EEOC, “voluntary” means “coerced, pressured, incentivized, and/or punished.” In other words “voluntary” means “involuntary.” (In the wellness industry, defining things as their opposites is par for the course. Health Fitness Corporation’s Chief Medical Officer has famously described the difference between making “life-saving catches of 514” Nebraska employees with cancer and admitting that these employees never had cancer at all as “semantics.”)

Fascinating! We wondered if there might be any literary precedents for defining this particular word as the opposite of what it really means.
Then we remembered George Orwell’s Animal Farm. Consider Napoleon’s decree that, in addition to an already 60-hour work week, the animals would be asked to work on Sunday afternoons as well:

          “This work was strictly voluntary, but any animal who absented himself              from it would have his rations reduced by half.”

Lessons Learned

We might take solace in the fact that the EEOC and the wellness industry settled on punishments of "only” 30% (roughly $1800) for employees who choose not to volunteer. Interestingly, one politician didn’t think that punishment would generate enough voluntary participation. He said we should impose penalties for all programs of 50% (now possible only for smokers); he must have been a big Orwell fan.

Aside from the self-serving albeit admittedly highly creative use of the English language, here are the problems with these guidelines:
·          It has been proven that forced voluntary wellness programs (the “pry, poke and prod” variety of programs) have not paid and cannot pay for themselves;
            Even the so-called best programs –the ones that win the Koop Award -- show trivial risk reduction (before adding back in dropouts and non-participants), and fabricate their savings figures;
             Screenings and HRA’s are more likely to lead to overdiagnosis and overtreatment than to health improvement;
          Many workplace programs--like those for weight loss--are completely ineffective, that is, when they are not busy harming employees;
         Thirty years of consistent and definitive research that the incentive approach being recommended does not lead to sustained behavior change and engenders a wide variety of iatrogenic consequences;
           These type of programs are highly unpopular with employees, which means they are much more likely to diminish than enhance employee engagement.

The real question here is not how much employers can punish employees who refuse to submit to forced “wellness or else” programs. The real question is: are these initiatives a good idea? And the answer, according to all the research not financed by the wellness industry itself, is a resounding NO! So how about asking Congress to put an end to involuntary, voluntary wellness programs, and instead allow only truly voluntary, voluntary ones?

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