Shedding Payments by Shedding Pounds

A recent column on Slate by Daniel Engber criticized the “Safeway Amendment” of the Senate’s proposed health care reform bill. Named for a supermarket that’s wellness program charges lower insurance premiums to those who lose weight or maintain a healthy weight, the Safeway Amendment would increase the incentives for results-based employee wellness programs by increasing the allowed insurance premium discount for such programs. Results-based wellness programs decrease employees premiums in reward for reaching specific health goals, such as losing weight, maintaining healthy blood pressure, or quitting smorking, as opposed to other wellness programs that decrease premiums based on more general attempts at healthier lifestyles, like joining a gym.

Engber claims the main problem with results-based programs, and in particular the program Safeway uses, is that the health goals they provide incentives for, such as maintaining a ‘healthy’ body mass index, don’t necessarily correctly measure health—and that the methods some may take to reach these goals, such as extreme dieting, may not be healthy. Furthermore, he is concerned about discrimination against those who have medical conditions that make it impossible to reach those results.

But does this mean the Safeway amendment itself is creating incentives for the wrong outcomes? No. This appears to be a case of bad regulation of a potentially good idea. If the Department of Health and Human Services created better regulations on what a healthy result is, and what methods must be taken to reach one, the Safeway amendment could have a beneficial effect on health—it’s a matter of establishing regulations that are specific enough to be worthwhile but flexible enough to be applicable to a set of people with drastically different genetics and medical conditions. This is admittedly difficult, and though any potential regulations will have their share of imperfections, encouraging result-based wellness programs still is a sensible idea; with a results-based program, an employee may decide to actually go to the gym they joined under a different type of wellness program.