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Consensus Elusive On Risky Behavior And Health Benefits

Wednesday, September 30, 2009 at 5:30 PM

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A study published in the The New England Journal of Medicine shows that our behavior - whether we smoke or drink, what we eat, and even what activities we pursue - is the main determinant of our health. But defining exactly what bad behavior is and how that should factor into health insurance costs is tricky. Wednesday, 90.3's the Sound of Ideas took up the issue, drawing a larger-than-usual number of calls and emails from listeners. Ideastream's Bridget De Chagas has more….

Views on how to define bad behaviors and what the consequences for those behaviors should be vary widely.  Helen from Euclid, for instance, is annoyed by the lack of personal responsibility many people take for their own health.

HELEN, EUCLID: “I DO MOST OF MY EXERCISING AT HOME.  I’M A WIDOW, I LIVE ON A VERY CLOSE BUDGET.  I GO TO MARCS, I GO TO ALDI’S.  THERE ARE PLACES… I STAND IN LINE BEHIND PEOPLE WHO ARE BUYING POTATO CHIPS, YOU KNOW, YOU KNOW WHAT I’M TALKING ABOUT.”

Rachel in Shaker Heights, on the other hand, believes bad behavior is more of a matter of degree. 

RACHEL, SHAKER HEIGHTS:  “IF WE MAKE PEOPLE RESPONSIBLE FOR THEIR OWN UNHEALTHY BEHAVIORS, WHERE DO WE DRAW THE LINE?  FOR EXAMPLE, I AM A STRICT VEGETARIAN BUT OCCASSIONALY I LIKE TO HAVE A GLASS OF WINE.  MY GOOD FRIEND DOESN’T DRINK OR SMOKE AT ALL BUT HE LIKES TO EAT RED MEAT.”

Jessica Berg, a professor if Bioethics at Case Western Reserve University agrees that it’s frustrating when people deliberately do things that are unhealthy and don’t take advantage of opportunities to improve their health.  But she doesn’t think penalizing people financially is a good solution. 

BERG: “ FROM A SYSTEM LEVEL IT’S NOT CLEAR THAT WE HAVE THE ABILITY TO DIFFERENTIATE BETWEEN DIFFERENT ACTIVITIES OR EVEN THAT WE SHOULD IN SUCH A WAY THAT WE’RE PENALIZING THESE PEOPLE BECAUSE FOR EACH INDIVIDUAL YOU’RE NOT SURE WHAT IT IS THAT’S CAUSING THAT UNHEALTHY BEHAVIOR.”

Berg believes there’s a more sensible way to coax people toward developing healthier lifestyles, expressed in this exchange with Sound of ideas Host Dan Moulthrop. 

BERG: YOU KNOW IT’S ALWAYS I THINK IN SOME SENSE MORE PALATABLE TO SAY IT’S AN INCENTIVE THAT WE’RE GOING TO GIVE YOU RATHER THAN A PENALTY THAT WE’RE GOING TO IMPOSE.

MOULTHROP:  “HERE’S AN INCENTIVE, YOU GET TO KEEP YOUR JOB!”

BERG: WELL, HERE’S AN INCENTIVE, WE WILL SUBSIDIZE YOU IN THAT WELLNESS PROGRAM.  WE WILL SUBSIDIZE YOU IN THAT SMOKING CESSATION PROGRAM.”

A caller named Tracy from Rocky River said his employer’s wellness program offered a large cash prize to employees for reducing their body mass index.  He’s lost 20 pounds.

While that may have worked for Tracy, J.B. Silvers, a professor of Finance and Healthcare at Case Western Reserve University doesn’t condone offering financial incentives.  He says people can’t be bribed into good health.

SILVERS: “They’re into good health because they’re educated, because they have - socio demographics are good, because they live in good neighborhoods, because they get to go to schools.  It’s a much broader framework than just a few incentive dollars that are thrown out there.  That moves you to the right direction, it’s not going to be enough to get you there.”

Carl Biats, President of Morningstar Insurance and Financial Services says work wellness programs have not been well attended and most employers are just trying to keep their heads above water.

BIATS: “MOST EMPLOYERS RIGHT NOW ARE TRYING JUST TO KEEP THEIR HEALTH PLAN.  I MEAN THEY’RE UPPING DEDUCTIBLES, THEY’RE UPPING CO-PAY, THEY’RE DREADING THE RENEWAL.”

As far as reducing risk based behaviors, Katy sent an email describing herself as a healthy 39 year old woman with great blood pressure, who exercises regularly, but weighs 254 pounds.  She wrote “For those who wish to penalize behavior, I’ll make a deal with you:  I’ll develop bulimia to help control my weight, if you promise no knee replacements for marathon runners.”

For 90.3, I’m Bridget De Chagas.

Tags

Government/Politics, Health

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