Burgers and Benefits

Posted on September 14, 2009


I’ve been thinking about corporate wellness programs of late, ever since reading an op-ed that appeared last week in the New York Times. The piece, “Big Food vs. Big Insurance” by Michael Pollan, brings a unique perspective to the continuing debate over health care reform by linking it to another important issue that, for the time being at any rate, is flying under the radar: how we eat in this country, and the reasons why.chi1

According to Pollan, “the American way of eating has become the elephant in the room in the debate over health care.” The heart of his argument can be seen in the following excerpt (emphasis is mine):

According to the Centers for Disease Control and Prevention, three-quarters of health care spending now goes to treat “preventable chronic diseases.” Not all of these diseases are linked to diet — there’s smoking, for instance — but many, if not most, of them are.

We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care. . . .

But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America’s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet. To put it more bluntly, the government is putting itself in the uncomfortable position of subsidizing both the costs of treating Type 2 diabetes and the consumption of high-fructose corn syrup. . . .

As for the insurers, you would think preventing chronic diseases would be good business, but, at least under the current rules, it’s much better business simply to keep patients at risk for chronic disease out of your pool of customers, whether through lifetime caps on coverage or rules against pre-existing conditions or by figuring out ways to toss patients overboard when they become ill.

But these rules may well be about to change — and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook — and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change.

The moment these new rules take effect, health insurance companies will promptly discover they have a powerful interest in reducing rates of obesity and chronic diseases linked to diet. A patient with Type 2 diabetes incurs additional health care costs of more than $6,600 a year; over a lifetime, that can come to more than $400,000. Insurers will quickly figure out that every case of Type 2 diabetes they can prevent adds $400,000 to their bottom line. Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits.

Pollan’s argument is quite relevant in the context of corporate wellness programs. The focus of most current programs is on things like smoking cessation, encouraging exercise and fitness, and better management of chronic health conditions. But maybe it would make sense to put a larger emphasis on nutrition.

So will healthier choices be coming to a company-subsidized cafeteria near you? Or maybe those hip workplaces that provide employees with free soda will be swapping Coke for carrot juice? My guess is that if Pollan’s points start to gain traction we will see more employers at least try to nudge employees into eating better, just as they have been trying to encourage them to take up other healthy habits.