Ezra Klein writes about the Cleveland Clinic’s efforts to cut its health costs:
“The Cleveland Clinic is best known for providing excellent health care. …
But the clinic has a more interesting – and more consequential – story to tell right now ….
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. …
Roizen says the initiative sprang from a single fact. … 70 percent of all medical costs are related to smoking, physical inactivity, food choices and portion size, or stress.
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. … [Roizen said:] ‘Then we banned smoking on campus. You can’t even smoke in the parking lot in your car. … We fired two high-profile physicians who refused to quit.’ …
Food came next. The clinic took out almost every deep-fryer in the building. They removed sugared soda from every beverage case. …
That left fitness and stress relief. … 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.
… The clinic tracks its employees’ blood pressure, lipids, blood sugar, weight and smoking habits. If any of these are what the clinic calls ‘abnormal,’ a doctor must certify that the employee is taking steps to get them under control. Otherwise, no insurance rebate. …
It appears to be working. Not only has the clinic cut its health-care costs, but its employees are also getting healthier in measurable ways. …
In one sense, the clinic has achieved the health policy ideal: cutting health-care costs by making people healthier. But consider how the clinic has done it – tying premiums to personal decisions, firing smokers, tracking employee metrics, eliminating popular sodas and foods from campus. …
The clinic no longer hires smokers. Will the obese eventually face similar hurdles? What about fans of fast food?
The experiment might work at a famed medical center where the CEO plausibly argues that aggressive leadership in health care is central to the institution’s mission. But would it work at General Motors? Caterpillar? Wal-Mart? Medicaid and Medicare?
Roizen thinks it can – and should. He estimates that an aggressive program could cut federal health spending by $300 billion to $600 billion a year. If he’s right, then simply instituting such wellness reforms could cut the federal deficit by far more than the Simpson-Bowles commission or the congressional supercommittee would. …
If we opt for Cleveland Clinic-style wellness programs, we won’t have to gut education, raise taxes or slash Medicare. And we’ll end up healthier. But … are we really ready to let employers – much less the government – tell us to quit smoking, skip the junk food and lose weight?
Megan McArdle, who pointed me to Ezra Klein’s article, is skeptical whether the Cleveland Clinic’s results can be replicated on a nationwide scale:
“One imagines that employees who do not want their employer nannying them about their gym time and alcohol consumption probably decline to work at the Clinic.
Selection bias will produce good results for the selecting organization, but you cannot replicate its results on a nationwide scale; fat, smoky people have to work somewhere (or go on welfare).”
But, of course (and I think Ms. McArdle might agree with me), the most important question is not whether government can replicate the Cleveland Clinic’s results on a national scale. The question is whether we want government to replicate the Cleveland Clinic’s methods.
It is one thing for a private employer to tell an employee how to live his or her life. Maybe it’s okay – though only as long as just a few employers do it and there are places that non-conformists can escape to.
But for a government? To tell this to everybody? I don’t care how much money can be saved. This is not something government should be doing. And these are not powers I want government to have.
But some governments have already raised taxes on cigarettes so high that they are virtually unaffordable. Other governments have effectively legislated Happy Meals out of existence. And there are proposals to put extra taxes on fatty foods or on sugared pop (“soda” to those out you who don’t live in the Midwest) because they’re “not good for you”. Aren’t these ideas precursors to what the Cleveland Clinic is doing – and what some people may soon be proposing that the federal government do to save money on health care?
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