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A Bad Case of “The Blues”

by Jon Robison, PhD, MS

Imagine getting a letter from your insurance company “inviting” you to participate in a “voluntary” program to improve your health. Imagine that you received this special invitation because your Body Mass Index (an unscientific, mathematically bereft proxy for health) is 30 or greater. Imagine that although this program is “voluntary,” if you don’t participate, it will cost you as much as $2,000 in added insurance premiums this year. To be fair, imagine that you do actually have a choice here: you can avoid the $2,000 price tag in this “voluntary” program if you agree to 1) wear a pedometer and enter at least 5,000 daily steps into the computer every 30 days or 2) join Weight Watchers or some other approved weight loss program.

Never mind that almost a third of the people who “volunteered” were pissed off and felt coerced into joining the program. (Actually, this was about a third of the only 12% of participants who bothered to answer the survey asking them how they felt about the program). Never mind that the criterion for being asked to participate was based solely on what you looked like rather than, say, how fit you were or how many steps you already walked in a day (because we know that all thin people already get the recommended amounts of daily physical activity). Never mind that none of the approved weight loss programs have ever demonstrated efficacy for anything other than weight cycling. And never mind that, since no pre-program data were collected, there was no way to have any idea whether the intervention increased people’s physical activity, improved their health or saved any money. Never mind, but welcome to Blue Care Network of Michigan’s Healthy Blue Living Program!

That is correct. Even in this era of coercive, incentive-laden wellness programs, we have sunk to a new low in the United States of America, where it is now okay to say to people that if they look a certain way, they have to submit to online, electronic monitoring or pay more for their health insurance than people who don’t look that way. If you are okay with that because after all, it just applies to fat people – you might want to think again. Better watch those bags under your eyes because not getting enough sleep is decidedly unhealthy. Maybe the next step will be demanding all folks with sagging skin under their eyes must electronically monitor their sleep every night or face stiff insurance penalties. Or what about daily breathalyzers to make sure you don’t go over the one or two drink limit, or nicotine tests or, or, or………… How much electronic surveillance are you willing to undergo based on the pure guesswork that it might save someone money?

What is even more amazing is the utter cluelessness that the authors of this so-called “scientific” peer reviewed article portray in their discussion of this intervention, which appeared in the May issue of the peer-reviewed journal, Translational Behavioral Medicine. In their conclusion, they brag about the “impressive and surprisingly high rates of program enrollment and adherence.” Hmm, let’s see, strap this pedometer on your body and plug it in to your computer, join a weight loss program, or else pay $2,000. Is it really that surprising that people “chose” to join the program? Am I missing something here?

And then there is this gem relating to how people felt about the program. At first, a full 47% of the people that filled out the survey said they felt bad about being coerced into joining the program. At the end, more than 30% still felt that way. It seems likely that many of the 17% who changed their minds lost weight during the intervention, although it will be interesting to see how they feel when they gain the weight back, which, according to the last 25 years of published research, most of them certainly will. In any case, here is the compassionate response from the authors:

Nearly a third of them did not like the program. Nevertheless given mounting costs associated with sedentary behavior, approaches to financially incentivize healthy behaviors are likely to expand and gain political support.

Never mind that there is no evidence that incentivizing people to change health behaviors in this manner works. (See my previous post on incentives in this blog.) Never mind that the people didn’t like it. Never mind that we don’t know if it increased the number of daily steps they took. Never mind that we have no idea if it improved health or saved money. Evidently none of that matters. Why? Because the benefits of using differential insurance premiums to drive health behaviors and outcomes demonstrated by Safeway (which of course, were completely made up) led our politicians and the health establishment to decide this was a good idea for everyone, and so they inserted an amendment into the Affordable Care Act detailing exactly how it should be done and we all drank the Kool-Aid and jumped on the bandwagon.

Come on Michigan, we can do so much better than this!

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