Klein: Brave New World of Compulsory Wellness
By Ezra Klein Oct 12, 2011 8:00 PM ET
The Cleveland Clinic is best known for providing excellent health care. A bustling, brisk medical campus, the clinic has been ranked the top hospital in the country for cardiac care for 16 years.
It treats Saudi sheiks -- and funds itself, at least in part, through their grateful, post-operation donations -- and is constantly toured by campaigning politicians looking to associate themselves with the best of American medicine.
But the clinic has a more interesting -- and more consequential -- story to tell right now, and it has nothing to do with providing health care to its patients and everything to do with curtailing health care for its workers.
With 40,000 employees, the clinic is the second-largest employer in Ohio. Like most employers, it struggles to contain health-care costs. But according to Michael Roizen, the clinic’s director of wellness, over the past seven years a series of reforms instituted by the clinic’s chief executive officer, Delos Cosgrove, slowed and then arrested the growth in employee health-care costs at the clinic. This year, inflation-adjusted spending might actually fall -- an all but unprecedented achievement in employer-based insurance.
What happened? Health care costs rose 6 percent a year nationally. Yet there was no rationing of care or squeezing of providers at the clinic. The clinic’s employees simply got healthier. Whether that success is a model for American health care or a preview of a dystopian surveillance state is an open question.
Common Problems
Roizen says the initiative sprang from a single fact. According to the Centers for Disease Control and Prevention, 70 percent of all medical costs are related to smoking, physical inactivity, food choices and portion size, or stress. Cut smoking, increase physical activity, persuade people to make better dietary decisions, and help them manage their stress, and you can reduce health-care costs before an employee ever steps into a hospital.
But consider what that actually entails: Changing habits. Breaking addictions. Getting people to the gym. Who wants to hear about any of that from their employer?
The clinic, however, didn’t give employees a choice. “First thing we said was we had to make our institution toxin free,” Roizen said. “The biggest toxin we have in the U.S. is tobacco. So we began offering free tobacco-cessation programs to our employees. Then we banned smoking on campus. You can’t even smoke in the parking lot in your car. The first offense you get a warning, and the second you get fired. We fired two high- profile physicians who refused to quit. Then they knew we were serious.”
Food came next. The clinic took out almost every deep-fryer in the building. They removed sugared soda from every beverage case. They eliminated trans fats. On a tour of the campus, I noticed a long line outside a McDonald’s. My guide sighed. McDonald’s, he explained, had a long-term contract that predated Cosgrove’s wellness initiative. The clinic couldn’t throw them out -- yet.
“We want to make it easy for you to do healthy things and hard for you to do unhealthy things,” Roizen said. “If you want a sugared drink, you have to go out of your way to bring it from home. We’re not going to provide it.”
That left fitness and stress relief. The first step was easy: Offer free fitness and stress-management classes. But the clinic still had to get its employees to attend. So they reversed the normal calculus. Usually, you have to pay to hit the gym or attend a yoga class. If you work for the Cleveland Clinic, you have to pay if you don’t.
“We raised the premiums for all employees,” Roizen said. But employees didn’t necessarily have to pay the increase. “If you’re doing a healthy program -- attending Weight Watchers or Shape Up and Go -- you get a rebate.”
Much more;
Bloomberg.com
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