Have you put on your “COVID 19?” If you’re among the many millions of people trapped at home who have put on weight during the pandemic, it’s understandable. But the humorous phrase — derived from the familiar “Freshman 15” of weight gain to which first-year college students are prone — is a serious matter. Whether we add 15, 19 or 25 pounds, adding notches to belts comes with a price tag. In many cases, business owners are picking up that tab.
As economists have been pointing out for decades, this nation spends way too much on healthcare; $3.7 trillion annually, in fact. And with our employer-centric system of health insurance, that cost burden falls heavily on America’s businesses. More than 50% of Americans are part of employee-sponsored health insurance plans; in 2019, the average cost of insurance per employee for family coverage was $20,576, with workers paying $6,013 on average toward the cost of their coverage. Taken together, employers paid nearly $880 billion in healthcare benefits for employees and their dependents, but this is only a slice of the pie. Illness-related productivity loss adds another $530 billion per year to employers’ bills, according to the Integrated Benefits Institute, a nonprofit health and productivity research organization.
The math is simple: more employees with chronic, non-communicable diseases (NCDs), such as heart disease or diabetes, add up to more visits to doctors and more medications prescribed — and millions of us count on employer-provided health insurance to save the day. We use it to see our healthcare providers, who recommend treatment, and to access medicines that address our arterial plaque or elevated Type 2 diabetes A1C levels or other health risks at, payer-negotiated, discount prices.
Without some intervention, the combination of NCDs will morph into more serious medical conditions. Louis J. Aronne, MD, FACP, the Sanford I. Weill Professor of Metabolic Research at Weill-Cornell Medical College, renowned obesity medicine scientist, and New York Times best-selling author of The Skinny on Losing Weight Without Being Hungry, reflects: “We know that 11 cancers are related to obesity and 50 illnesses are a direct result of an increase in body fat, so this is an obvious target for chronic disease management.” Now, we are no longer talking about just needing another belt notch, but rather people struggling for life.
Spurred by an explosion of illnesses that result from weight gain, the sedentary lifestyle and poor nutrition, healthcare costs continue to rise — enabled by a society that abandoned the cheapest and best primary prevention path of good diet and exercise for a path that took less effort: “Write a script and take a pill.”
Consumer Reports, that bastion of smart purchasing for cars and home appliances, writes in its 2019 national survey that “30% of Americans who currently take prescription medicine say their out-of-pocket cost for a drug they regularly take has increased in the past year,” and of those, 12% saw their drug’s prices increase by $100 or more. Those who saw spikes in their out-of-pocket costs “forgo other medical treatments or tests, cut back on groceries, or get a second job.” The falling dominos of chronic illness and employees doing nothing or taking medications instead of embracing healthier practices leads to more and deepening serious illness.
America may be the land of the free, but it is also becoming the home of the chronically ill.
Now, corporate leaders must look unflinchingly at the underlying causes of our healthcare costs and ask: “Why is our nation getting sicker — why are my insurance premiums increasing year-to-year?” We need an intervention.
Corporate strategies need to change and company executives committed to employee safety and well-being need to roll up their sleeves and become their businesses’ public health advocates.
The solution is not continuing to write checks for sick care; it is rallying to support workplace wellness.
Health innovator Jeff Ruby, who founded habit change provider Newtopia* to mobilize corporations to prevent, reverse and slow the progression of chronic disease within their employee communities, writes in Medika Life:
The health that corporate America pays for today is backward. The focus on footing the bill for sick care for employees (or members) — instead of offering primary lifestyle prevention to keep our people healthy — costs individuals, businesses, and society a fortune and is completely unsustainable. It’s the equivalent of working to restore loyalty to an unhappy customer instead of focusing on delivering a world-class experience from the first touchpoint and keeping customers happy and loyal along the entire customer lifecycle.
We are a nation that neglects the basics, even if they can save us time and money in the long-term. That’s a big error when it comes to people’s health. We seed illness at the earliest years by cutting back investments in healthy lunch and exercise and sports programs at the primary- and secondary-education level. This almost ensures employers inherit an unhealthy workforce expecting a “free doughnut,” whether it’s for attending a business meeting or getting a life-saving vaccination. Right now, our approach is to invest in managing sickness in America.
Controlling health insurance costs can no longer rest on the three-pronged, short-term strategy of shopping around for a new carrier every three to five years, slicing off drug benefits and shifting costs onto employees. Employers need to embrace behavioral and digital support programs that put the “health” back in their strategic health insurance planning to foster a healthier workforce and more productive workplace.
After company-hired benefits consultants and pharmacy benefit managers drive down drug costs for noncommunicable illness treatments, company executives will still see their health insurance budget line still continue to climb. In ignoring the bigger opportunity to support employee health, they fund the status quo of illness. NCDs perpetuate and increase insurance costs, and will cause a cumulative loss of output of $47 trillion between 2011 and 2030. That’s a sinkhole companies can avoid. For companies subsidizing employee insurance, it’s time to shift from risk management and seek greater return on investment. Wellness is good business for companies. Those companies that contribute to their employees’ health demonstrate corporate social responsibility to their community.
It is essential that company executives stop focusing their resources largely on treating preventable health risks, and instead begin to think about enabling employees to avoid illness by encouraging healthy mindsets and behaviors and tapping into trained wellness coaches and digital-health applications. By investing in reaching meaningful targets (e.g., weight loss, fitness, better nutrition, workplace safety and mental health), business leaders will regain control over looming healthcare bills and actually improve employee well-being.
Face it: climbing health insurance premiums and drug formulary costs are symptoms of a bigger problem. Let’s target the real culprit by challenging the status quo of preventable disease. If we don’t, it will kill us.
[Special appreciation to Finn Partners colleagues Arielle Bernstein Pinsof, John Bianchi and Shira Friedman for their comments and recommendations.]
Disclosure: Newtopia Health is a client of my employer, Finn Partners. All content expressed here is my own. I also serve as a corporate strategic advisor to Newtopia Health and any and all funds received are donated to a not-for-profit charity to benefit rural renewal and are not in my control.