The spirit of entitlement - perhaps inaptly named - is very much alive in 2006. Health insurance is, of course, thought of as part of an employee's compensation package today, but that's only a technicality. Increasingly and, perhaps, inevitably, more and more Americans are coming to regard healthcare as a basic necessity and right. It's only a small step from that stance to the subsidization of club memberships, diet plans, nutritional supplements, and many other preventive healthcare measures.
Physical fitness will soon be considered a standard health benefit - even an entitlement.
In favor of subsidization
Health is a cherished American value, and the endless torrent of research linking regular exercise to better health is almost, but not quite, tedious. People believe in, and endorse, the subsidization of preventive healthcare - partly from a sense of entitlement, but also because many lack self-discipline, and require the extra motivation provided by financial incentives. According to a 2004 survey conducted for IHRSA by Ketchum Global Research Network, Americans strongly support efforts by health-insurance providers, employers, and government to promote physical fitness and a healthy lifestyle. While independent research sources have come to the conclusion that only one out of five people exercise on a regular basis, the IHRSA study found that:
Three-fourths of Americans (77%) would be "very" or "somewhat" likely to exercise if they paid a lower health-insurance premium;
70% believe that patients should be reimbursed for physician-prescribed fitness/exercise programs;
Eight in 10 Americans (82%) say they would exercise regularly if their employer subsidized health club memberships;
And six out of 10 (61%) believe that Congress should do more to promote physical activity and prevent obesity.
Healthy lifestyle incentives
According to a 2002 study conducted for IHRSA by American Sports Data, Inc. (ASD), consumers have a clear sense of which subsidized benefits they'd prefer. The following are the benefits they'd like, ranked by order of preference. *
1. Full medical checkup
2. Exercise classes
3. A health club membership
4. Nutritional counseling
5. Smoking-cessation program
6. Weight-control program (e.g., Weight Watchers)
7. Medical care for sports/exercise injuries
8. Other preventive care (e.g., chiropractic, massage therapy, etc.)
9. Stress-reduction program (e.g., yoga, biofeedback, etc.)
10. Home exercise equipment
11. Nutritional supplements (e.g., vitamins/health foods)
12. Services of a personal trainer
13. Fitness-monitoring devices (e.g., heart-rate monitor, pedometer, running log, etc.)
14. Athletic footwear/apparel
15. Home-exercise videos
16. Special diet product
* Prescription drugs and surgery for obesity not ranked
Pioneers of prevention
Most HMOs will pay for medically based preventive healthcare (e.g., screenings and vaccinations), but, until recently, the subsidization of healthy-lifestyle initiatives seemed too new, radical or "frivolous" an idea to merit serious consideration. Smoking is still regarded as a vice and, therefore, is undeserving of special preventive attention; and, for the old guard, physical fitness activities are still defined as "recreational pursuits." Even in the face of the well-documented obesity epidemic, there are some reactionary forces that view subsidized weight-control programs as, at best, a concession to the self-indulgent and, at worst, simply cosmetic and narcissistic.
Lacking the imprimatur of medical legitimacy, the incentivization of healthy-lifestyle behaviors doesn't yet command the urgency-or dollars-accorded to acute healthcare, disease management, or even the more compelling medical versions of preventive healthcare. But the recent sanction of obesity as a bona fide "disease" by Medicare could change everything.
Even before the new ruling, major institutions, particularly ones in the private sector, had overcome major obstacles. Among them:
In July 2004, Medicare redefined obesity as an illness, a dramatic shift in policy that may allow millions of Americans to file medical claims for counseling, diet programs, prescription drugs, and even obesity-related surgery. Because private insurers often follow Medicare's lead, the decision is monumental. But, here, the focus is still on remedial, rather than preventive, approaches.
In March 2004, Tommy G. Thompson, then the U.S. Secretary of Health and Human Services (HHS), urged Congress to offer tax credits to people who lose weight, and exhorted insurance companies to offer reduced premiums to those who keep the pounds off.
In August 2005, physician-prescribed remedial (not preventive) exercise programs for specific health issues were allowed by the Internal Revenue Service (IRS) as "qualified medical expenses."
In September 2005, hoping to curb runaway Medicaid costs, the state of Michigan announced a plan to incentivize healthy behaviors, such as smoking cessation, weight control, and keeping doctor's appointments.
Under a 2005 agreement, county workers in King County, Washington, will earn points for their healthier-living and improved disease-management efforts, including smoking cessation, seatbelt usage, diabetes monitoring, and cholesterol screening.
The 2004 Benefits Survey, conducted by the Society for Human Resource Management (SHRM), revealed that 30% of the participating firms subsidize fitness center memberships, and that 50% of the large companies (500-plus employees) subsidize employee weight-loss programs. The industries that are most likely to subsidize fitness centers are: government (39%); manufacturing (39%); health (36%); technology (32%); and retail (31%).
The Oxford Health Plan offers a $200 rebate - the check is mailed directly to the policyholder - to insureds who can demonstrate that they've attended a health club at least 50 times during the prior six months. Oxford also offers a 10%-40% discount on a wide range of healthy lifestyle expenditures, including exercise equipment, diabetic products, weight-loss programs, fitness publications, spa services, eyewear, and yoga and Pilates programs.
PacifiCare Health Systems offers prizes to members who enroll in and maintain a disease-management or preventive-healthcare-behavior regimen.
Aetna provides a discount on health club memberships for its dental and medical participants, but not for club utilization without a membership.
Participants in the five-year-old Destiny Health program are awarded points for taking a CPR class; initiating an exercise program; losing 10 pounds in six months; checking their cholesterol level; and using the Internet to look up health-related information.
The HIP Health Plan of New York offers members a 30% discount on fitness, massage, relaxation, acupuncture, and other related services.
