Big Brother Has a New Face, and It's Your Boss

Big Brother Has A New Face, And It's Your Boss

April 26, 2013

Forbes - Recently, the CVS Caremark Corporation began requiring employees to disclose personal health information (including weight, blood pressure, and body fat levels) or else pay an annual $600 fine. Workers must make this information available to the company’s employee “Wellness Program” and sign a form stating that they’re doing so voluntarily.

CVS argues this will help workers “take more responsibility for improving their health.” At one level, this makes a certain sense. Because the company is paying for their employees’ health insurance, they naturally prefer healthier workers. But at a deeper level, CVS’ action demonstrates a growing problem with our current system of employer-provided health insurance. If our bosses must pay for our health care, they will inevitably seek greater control over our lifestyles.

Although most Americans take it for granted that they receive health insurance through the workplace, this is an artifact of federal tax rules from World War II. When the U.S. government imposed wartime wage controls, employers could no longer compete for workers by offering higher salaries. Instead, they competed by offering more generous fringe benefits such as health insurance. In 1943, the IRS ruled that employees did not have to pay tax on health benefits provided by employers; in 1954, the IRS made this permanent.

The federal government thus distorted the health insurance market in favor of employer-based plans. If a company paid $100 for health insurance with pre-tax dollars, the employee enjoyed the full benefit. But if the employee received that $100 as salary, he could only purchase $50-70 of insurance after taxes. Over time, this tax disparity helped employer-based health insurance dominate the private insurance market. In 2008, over 90% of non-elderly Americans with private insurance received it through their workplace.

Hence, government policy artificially injects the employer into the relationship between a patient and the health insurance system. Normally, what a worker ate or whether he smoked at home would be of no concern to his boss (unless it affected job performance). But U.S. government policy makes it the employer’s business.

To make matters worse, ObamaCare reinforces this status quo. ObamaCare requires large employers to offer health insurance to workers (or else pay a penalty). As a result, more people are discussing how best to link employment to healthy behavior.

For example, the New England Journal of Medicine recently featured a pair of high-profile editorials debating the merits of allowing companies to discriminate against smokers, “for their own good.”

Furthermore, ObamaCare pays government grants to encourage companies to implement these “wellness programs.” Hence, employers who wouldn’t otherwise concern themselves with workers’ lifestyles now have an incentive to do so in order to collect federal funds.

My state of Colorado is even attempting to lure businesses from other states by arguing that Coloradans are less obese (and thus incur fewer medical expenses).

Note that the issue of employers controlling employee lifestyles arises because the government artificially couples employment with health insurance. In contrast, we don’t receive automobile insurance or homeowner’s insurance through our jobs. Hence, most employers don’t care about employees’ driving records or the number of smoke detectors in their houses. There are no “safe driver” workplace programs along the lines of “employee wellness programs.”

This is the flip side of coupling health insurance to employment. Some employers (like Regal Cinema) are cutting back on worker hours to reduce those insurance costs. Others will still cover their employees — but will want to monitor those employees’ health and activities.

Instead of reinforcing the current system linking health insurance to employment, we should uncouple the two. We should equalize the tax status of employer-provided health insurance with insurance purchased by individuals outside of work. This is a key element of many free-market health reform plans (such as Docs4PatientCare.org “Prescription for Health Care Reform”). This would also help create a robust market for truly portable insurance that stayed with the customer when he changed jobs (just as one’s auto or homeowners insurance is unaffected by job changes).

As a physician, I encourage everyone to adopt a healthy lifestyle, including proper diet and exercise. It’s also entirely appropriate for insurance companies to charge higher rates for customers who smoke or engage in other unhealthy activities. Likewise, employers and workers should be free to voluntarily agree to contract terms that include incentives for healthy behavior, provided it’s without government nudging.

But it’s wrong for the government to use economic carrots and sticks to induce private employers to become enforcers of healthy behavior. This is just a subtler form of “nanny state” controls, such as NYC mayor Michael Bloomberg outlawing soft drinks he considers unhealthy. And once employers start monitoring employee behavior on the grounds of “health costs,” there’s no end to the potential meddling. Who will be the next politically disfavored group after smokers or the obese? Do we want bosses discouraging their employees from owning guns or enjoying mountain biking on the weekends? This is a dangerous road.

The nanny state is bad enough. We don’t need nanny bosses.

NWO Order Plans Exposed by Insider in 1969: One World Government Under the Devil Without Liberty or Justice for All (Excerpt)

By Dr. Lawrence Dunegan, Pittsburgh Pediatrician Who Died in January 2004
March 1988 (Recollections from a Lecture Given on March 20, 1969)

[...]

The next topic is Medicine. There would be profound changes in the practice of medicine. Overall, medicine would be much more tightly controlled. The observation that was made in 1969 that,

"It is now abundantly evident that Congress is not going to go along with national health insurance. But it's not necessary — we have other ways to control health care".

These would come about more gradually, but all health care delivery would come under tight control. Medical care would be closely connected to work. If you don't work or can't work, you won't have access to medical care.  

The days of hospitals giving away free care would gradually wind down, to where it was virtually non-existent. Costs would be forced up so that people won't be able to afford to go without insurance.

People pay for it, you're entitled to it. It was only subsequently that I began to realise the extent to which you would not be paying for it. Your medical care would be paid for by others. Therefore, you would gratefully accept, on bended knee, what was offered to you as a privilege. Your role being responsible for your own care would be diminished. As an aside here, this is not something that was developed at that time; I didn't understand it at the time that it was an aside.

Here's the way this works: everybody has made dependent on insurance, and if you don't have insurance, then you pay directly, and the cost of your care is enormous. The insurance company, however, paying for your care, does not pay that same amount. If you are charged, say, $600 for the use of an operating room, the insurance company does not pay $600; they only pay $300 or $400. That differential in billing has the desired effect: It enables the insurance company to pay for that which you could never pay for. They get a discount that's unavailable to you. When you see your bill you're grateful that the insurance company could do that. And in this way you are dependent and virtually required to have insurance. The whole billing is fraudulent.

The solo practitioner would become a thing of the past. A few die-hards might try to hold out, but most doctors would be employed by an institution of one kind or another. Group practice would be encouraged, corporations would be encouraged, and then once the corporate image of medical care gradually became more and more acceptable, doctors would more and more become employees rather than independent contractors. Along with that, of course, unstated but necessary, is the employee serves his employer, not his patient.

So we've already seen quite a lot of that in the last 20 years. And apparently more on the horizon. The term HMO was not used at that time, but as you look at HMO's you see this is the way that medical care is being taken over since the National Health Insurance approach did not get through the Congress.

A few die-hard doctors may try to make a go of it, remaining in solo practice, remaining independent (which, parenthetically, is me) but they would suffer a great loss of income. They'd be able to scrape by, maybe, but never really live comfortably as would those who were willing to become employees of the system. Ultimately, there would be no room at all for the solo practitioner after the system is entrenched.