The Integrator has repeatedly returned to the theme of incentivizing behavior because many hard issues must be held in balance (compassion, personal responsibility, economics, individuality, public health) and because Integrator columnist Michael Levin has repeatedly focused on the subject.

Here the writer, Integrator reader Charlie Priester, responds to Levin, to new research as reported in the New York Times and to recent Congressional perspectives from the perspective of a self-insured consumer and user of integrative services who has been close to the integrative practice field for a decade. Priester is a former colleague in publishing the hard-copy Integrator (1998-2002), the Industry Health News Files and the Collaboration for Healthcare Renewal News Files and in developing the Integrative Medicine Industry Leadership Summits (2000, 2001, 2002).

Guest columnist Charlie Priester: One mandate deserves another

"After I read the latest issue of the Integrator Blog, specifically the column from Michael Levin entitled “Financial Incentives for Wellness: Good for Integrative Practice?” I was uncharacteristically moved to send a comment.

"My first reaction was to target weight loss: 'Even though Senator Ensign is a little like having the Wicked Witch of the West as a co-sponsor, you know I’ve been arguing for years that there ought to be some kind of financial incentive for wellness. No easy way to do it, I agree, but obesity and even just “overweightness” is clearly out of control in this country, and there’s plenty of evidence regarding the probability of a whole host of health issues based on it….'

Are these incentive programs 'good for integrative practice?'  Well, they sure ought to be.

"The following day, an article in the New York Times appeared, citing a report by Kenneth Thorpe, which projects that if current trends continue, 43% of American adults will be considered obese by 2018. The number as of 2008 is 31%, which is scary enough, and that’s just adults!

"After doing a little more research, I came to realize that my first reaction basically lands in the 'Safeway Amendment' camp. Safeway CEO Stephen Burd offers his employees a break on their premiums if they meet certain criteria re: smoking cessation, weight, cholesterol and blood pressure. If they succeed at all of them, they can save as much as $800 per year on their share of premiums. In a Wall Street Journal editorial, Burd wrote that 'if the nation had adopted our approach in 2005, the nation’s direct healthcare bill would be $550 billion less than it is today.'

"Essentially, this 'outcomes' argument is that employers (and perhaps the government) should adopt the auto insurance model, which rewards or penalizes certain behaviors. No employee has to lose weight or quit smoking (this is America, after all), but there’s a financial incentive to do so.

"Every article I read adds to the complexity of the issue, but I keep coming back to the certain belief that no matter what Congress does regarding health insurance reform, if U.S. citizens don’t start to exercise more and change their diets to include more fresh, real food, healthcare costs will continue to spiral out of control.

	If the government is really interested in taking on the bigger public health crisis we face, and if they are in the end going to mandate that everyone buy insurance, I say they ought to demand that health insurance companies themselves offer financial incentives to encourage healthier lifestyle choices.

“'Good for Integrative Practice?' you ask. Well, it sure ought to be, if for example, naturopaths could take all their expertise in the realm of nutrition and develop some 'certified' educational programs that employers could offer to employees. Or if acupuncturists could make the case that their treatments will help an individual achieve the outcomes that a Safeway demands. Or if yoga instructors harnessed the popularity of their discipline and persuaded employers that their classes should be considered as worthy of subsidy as gym memberships.

"For the self-employed and self-insured like myself, I wish insurance companies would offer discounts to people who eat well, exercise regularly, and meet whatever 'Safeway'-like criteria they want to set up. If the government is really interested in taking on the bigger public health crisis we face, and if they are in the end going to mandate that everyone buy insurance, I say they ought to demand that health insurance companies themselves offer financial incentives to encourage healthier lifestyle choices.

"Of course, as long as we’re at the mercy of our current for-profit health insurance industry, and so long as that industry makes money off self-motivated folks who pay premiums and rarely have claims, this is probably not going to happen."

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"Mr. Thorpe concluded that the prevalence of obesity is growing faster than that of any other public health condition in the country’s history. Health care costs related to obesity — which is associated with conditions like hypertension and diabetes — would total $344 billion in 2018, or more than one in five dollars spent on health care, if the trends continue. If the obesity rate were held to its current level, the country would save nearly $200 billion a year by 2018, according to the study."