Pay Up! No Evidence Required

WTFThe rules about workplace wellness programs under the Affordable Care Act were released jointly by the U.S. Departments of Health and Human Services, Labor and the Treasury. The include provisions to charge employees up to a 30% penalty (sometimes couched as an “incentive”) if they fail to meet a” specified health-related goal such as a specified cholesterol level, weight, or body mass index.”

There are a couple of obvious issues.  BMI and weight are body size measures, not health measures (there are healthy and unhealthy people of every weight and size); and, body size, cholesterol and other measures are multi-dimensional and not entirely within our control.

And it’s not like they don’t know.  At a briefing sponsored by the Alliance for Health Reform and the Robert Wood Johnson Foundation, panelists were refreshingly honest that there is no proof of the financial or health improvement value of these wellness programs.  In fact, a Rand Corporation study on wellness programs that was  actually requested by HHS found:

  • No significant reductions in levels of total cholesterol
  • Insignificant cost savings
  • People typically quit smoking for the short term only
  • Almost no reduction in emergency rooms or hospital cost or use
  • Participants lost an average of only 3 pounds in 3 years

So, employees are going to be penalized for failing at programs that have been shown to fail in a study that was requested by the people who created the penalty structure.  Charming.  I wish for the good old days when the government was just going to give every fat person a pony.

But the absolutely most ridiculous bit for me was the quote by Troyen Brennan.  He is the Executive Vice President and Chief Medical Officer of pharmacy chain/pharmacy benefits manager for CVS Caremark. He said “We’re not sure what works. There’s got to be peer-reviewed data and it’s simply not there…[CVS Caremark is] embedding experiments in all of our wellness programs…The annals of health care are full of things that seem like a good idea but show no effect.”

I know you’re thinking “that makes a lot of sense Ragen, why would that upset you?”  It’s because CVS Carmark bragged about implementing a so-called wellness program in which employees must go to a doctor to get their weight, body fat, glucose, cholesterol, and blood pressure measured, and submit those measurements to a third party healthcare company. They are required to sign a form saying that they are giving this information voluntarily, but if they don’t “volunteer” they are charged an extra $600 a year by CVS. The CVS policy states “Going forward, you’ll be expected not just to know your numbers – but also to take action to manage them.”  If Troyen Brennan knows that “peer reviewed data” is necessary, why in the hell is he bragging that they are conducting poorly controlled, non peer-reviewed “experiments” that are funded by the subjects (also known as typically lower income workers.)

When I did a piece for iVillage on Michelin’s corporate wellness program that fines employees up to $1,000, I contacted the Employment Equal Opportunity Commission to see if this is even legal.  Justine Lisser, Senior Attorney-Advisor for the EEOC informed me that  “While normally the ADA [Americans with Disabilities Act] would prohibit an employer with 15 or more employees from asking questions about disabilities or requiring a medical exam (like a blood test to measure cholesterol), an exception is made for voluntary wellness programs…[But] if an employee fell outside some of the metrics imposed by the employer due to an underlying disability — for example, if a person needed to take medication for a psychiatric disability that caused weight gain — it might violate the ADA for the employer to penalize that individual for not meeting certain benchmarks.”

According to the HHS,  “The final rules also protect consumers by requiring that health-contingent wellness programs be reasonably designed, be uniformly available to all similarly situated individuals, and accommodate recommendations made at any time by an individual’s physician based on medical appropriateness.”

Which might help in a world where fat people aren’t prescribed weight loss to cure everything from strep throat to broken bones by doctors who don’t know the difference between body size and health and often carry a serious personal prejudice against us.  But I’m sure they’ll be super happy to sign our “Please don’t charge me more money for existing” permission slip.

Penalizing people for their body size sets a precedent that it’s ok to charge people more because they share a single physical characteristic.  Penalizing people for their health ignores the complexities of health, and since their tends to be a strong link between lower socioeconomic status and lower income, the burden of these programs is likely to be shifted to those who are least able to afford it.  Also, and this can’t be said enough, it doesn’t work.

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Published in: on June 5, 2013 at 10:43 am  Comments (52)  

52 CommentsLeave a comment

  1. This is sad and disturbing. I feel bad for those who work at companies with ‘wellness’ programs.

  2. CVS needs to butt out of medical care! Last time I checked they are not a medical doctor! I am so sick of them controlling where I get my prescriptions filled and all there other crap!

    You know my mother would have flunked their tests. Mind you the woman only weight maybe 100 lbs soaking wet but her cholesterol was out of sight and her BP too! But she was lucky enough to have lived when medical care was left to her doctor and not the insurance companies and pharmacies!

  3. My health insurance doesn’t cover “well visits,” so I have to pay out of pocket for an annual physical at my doctor’s office. As an “alternative,” my workplace (through the health indurance provider) does bring in nurses once a year to draw blood for the standard battery of tests (cholesterol, fasting blood sugar, etc.) and they offer to send those lab results to our primary care doctors. They market it as a way for us employees to save money (it only costs $15) but I’d still rather pay out of pocket and go see my own doctor to have these tests done, for two reasons: a) I need to see my doctor regularly anyway because I’m working closely with her to manage my chronic hypothyroidism, and b) I just plain do not trust my employer when it comes to my private health data. I have no way of knowing what or how much of my information they will have access to, nor do I know what they might do with that information… raise my premiums? Force me into some “voluntary” wellness program? Ugh. I hate paying out of pocket (what kind of health insurance plan doesn’t cover PREVENTIVE care?) but I’d rather pay more and know that my lab results are between my doctor and me.

  4. I blogged about wellness progams the other day. The thing that astonishes me is that nobody outside of FA has taken up the civil rights issue around these programs. Requiring employees – and the ‘voluntary’ aspect of them isn’t voluntary at all – to be tied to electronic monitors like pedometers while submitting to intrusive and invasive medical exams is an extraordinary assault on the principle of bodily autonomy.

    People who would go to the barricades to defend a woman’s right to her own reproductive choices have been silent on the way the body is being moved from being a private entity (“it’s my body”) to being a public entity that everybody can have a say in. Yet bring it up and people from all sides of politics fall silent in the face of the “but it costs us money” argument.

    • I’ve said the same thing! And it’s amazing the level of fat bias that comes into play. I had someone make a comparison recently that being fat is like being a cigarette smoker, and we know smoking cigarettes isn’t healthy, even if one smoker might be overall healthy… the “it will catch up to you” argument.

    • So very true. It is disturbing how many should-be allies are MIA on this issue

  5. It’s weird that companies cannot discriminate based on “perceived illness,” but are more than happy (and allowed) to do so based on “presumed illness.” What kind of a system is that?

  6. I foresee this happening where I work – a non-profit healthcare organization. They’ve had the health assessments for several years now, then the past few years they’ve tied the health assessments to our premiums by offering a discount if we participated. The new one for next year is that they’re going to put “extra” money into our healthcare reimbursement funds if we meet certain criteria including the health assessment.

    A friend in a different department said she’s waiting for the “chubby charge” to be assessed. Then added, “Bring it on.” I’ve been waiting for that kind of charge since they rolled out the “non-smoker” discount a few years ago. I knew then that the next step was to have a BMI charge/discount. So I’m waiting for the other shoe to drop.

    If the charges get too high, it may well be worth the spousal surcharge to be put on my husband’s policy. It’s not like what I have now is that much better, unlike how it was when I first started here six years ago. Our benefits have gone downhill, while we’ve had to jump through hoop after hoop AND pay more for it. Not that I’m a bitter about it or anything. :/

    • I so feel your pain… same situation here. In 2009 my husband had a major pay cut, and the increases in our insurance benefits have prevented him from getting any of that back. Even though the economy has improved somewhat, the health care costs have skyrocketed to the point that they still haven’t given him a raise.

      And now I have to wonder how long before the government takes the “our way, or you pay” approach. Poor people have a higher rate of obesity, and they are the ones who are benefiting most from the AHCA. What happens when the government decides to go all Michael Bloomberg on them?

      I really think this country’s “War On Obesity” is too extreme to allow them this level of control and say on our healthcare choices. I’ve always said this, and especially given this particular Administration’s known feelings on weight, it makes me very nervous.

  7. It is particularly galling that CVS – a place that sells crap, junk food and cigarettes if I’m not mistaken, invokes this kind of policy for it’s employees. This is why I sit on our company’s wellness committee to ensure we never go down this path.

  8. Ugh, these kinds of programs are just awful. Bleh.

    One of the insurance plans offered by my company has a different kind of incentive–I’m curious how you feel about it. The plan comes with a $300 deductible, but this is completely removed if you have a well-patient physical (free of charge) with your doctor once every 18 months. The doctor fills out a little form that you submit. The important thing here is that the insurance company doesn’t care at all WHAT shows up on your physical–there is no reward or punishment for how “healthy” you are or aren’t. They don’t even see the specific results, just that you discussed a couple specific topics (smoking, flu shots, cholesterol, etc) with your doctor. The idea is to encourage people to go to the doctor regularly (this especially an issue for men, apparently) for a check-up. I think this is a MUCH better way to incentivize healthy behavior, and it allows you to set your own goals and priorities about what is important to you. Also, my company offers two other plans if you don’t want to deal with what this one requires (although they are a little bit more expensive).

    • I think that this is better, but I’d have to see what gets turned in. I don’t believe that people should be required to turn over any health information to their employer and if weight was one of the things that is on the list of things that you are required to discuss I’d have an objection. I’ll admit that I worry that this type of program will transition into a more “carrot and stick” approach. I also think that people should be able to choose healthcare providers who are not Western Medical practitioners but that is a blog for another day. I think this is a better option if not perfect.

      ~Ragen

    • That is an incentive plan I could very happily support.

  9. And people wonder why I don’t trust our government – particularly one in which Michelle Obama has much too much of a voice – to handle our healthcare choices. I’ve been extremely opposed to Obama’s healthcare plan from Day 1. Until this society stops making health judgments based on appearances, I want no part of a government controlled healthcare system. None.

    Not to mention, our insurance costs have gone up almost $3000 a year since all this began, AND that’s on a crappier plan than we had when he took office. I pay $50 for a primary care visit and $75 for a specialist. My primary doctor is a reasonable, intelligent person who understands that weight doesn’t have any relation to strep throat. But every time I spend $75 to see a specialist, I worry I’ll get the “you need to lose weight” speech, and not get any help for what is actually wrong.

  10. I’m really disturbed by this whole idea of “voluntary”. If they say to you, do it or we will charge you hundreds more…. Then it’s really no longer voluntary is it? It’s glorified blackmail. Because anyone who can’t afford it doesn’t get a choice at all. It seems like the very programs touted to help the poor, have been twisted to punish them instead.

    Sent from my iPhone

  11. I can’t wait for the first court case challenging these programs for the exact reason Lisser laid out. Although weight is largely out of our control, most people persist in believing that anyone over a size 6 is just eating too much fast food, the courts would have to rule in favor of this hypothetical person on, say, steroids. That would open the gates to questioning whether anyone should be penalized for weight under these programs, and the whole system would be knocked ass over teakettle. Sign me up for that class action suit, please!

    • I’m right there with you, Kris! Too much fast food my ass. I have fast food maybe a half dozen times a year–I just don’t like it all that much and generally eat it when I’m on the road and I’m super duper pressed for time. One of the skinny guys at work eats fast food every day for lunch.

      • And that’s definitely skinny guy’s right – no one, not his family, not his workplace, not society in general has the right to tell him not to patronize Burger King. It just annoys the hell out of me that if he’s not within a normal range on his cholesterol or his blood pressure, he’ll get treated for his problem, not his size, while in the meantime, an overweight person who may or may not have the same habits will merely get told to lose weight.

        I’m like you – by nature, I just don’t happen to like fast food that much, or heavily processed food in general. Even when I was little, I tended to shy away from fried foods and red meat, and towards chicken, seafood, veggies, and fruit. My husband did/does like fast food, restaurants, etc, but because of economy (and because I’m a good cook, if I do say so myself), he’s become a fan of eating whole foods at home. His diet has changed completely; dinners this week are broiled salmon with fresh rosemary and garlic, ginger-cilantro-sesame baked tilapia, tomato-basil shrimp with whole wheat pasta, and homemade broiled crab cakes. He takes fruit to snack on every day at work.

        And yet, his doctor persists in telling him that the key to lowering his high cholesterol and blood pressure is to change his diet and lose weight.

        WTF? I went to her once; she tried to prescribe weight loss to treat my depression. My husband has no clue why I don’t like her and refuse to go back to see her.

        • I hear ya Kris! I never give skinny dude crap for eating what he wants! Some of the other guys used to, but I asked them to stop.

          Now, he is considering changing his routine because he’s looking to buy a home and asked me about the lunches I bring in, asked me how much my grocery bill is/how long it takes me to make the stuff I bring in. I’ve given him some of my simpler/cheaper recipes to try out. But I can’t help him much with a grocery bottom line–I’m a military spouse so I get to use the Commissary, which is much cheaper than regular stores here in MD.

          And I haven’t been cooking as much as I’d like as of late… I keep a stash of Campbell soup on hand for the days I just can’t put together a lunch from home.

  12. One: I would so sign that permission slip.🙂

    Two: I recently had a friend who, at not quite 40, went into heart failure and may end up with a double bypass. She is a large woman, in that she is tall and wide and solidly built. She is maybe 20-30 lbs over the stupid BMI recommendations. She is also a vegan, has been for over a decade (yes an “I eat a crap ton of veggies vegan” not really a fake processed food type eater), and exercised regularly until she got sick at the beginning of the year and started to go downhill. Her cholesterol has been high since her 20’s, not matter what she did. In her case, I would diagnose familial hypercholseretolemia. Those people will find it difficult to impossible in the conventional medical world toget their cholesterol down, probably even with drugs. Now, in the naturopathic world, we have some more tools to help, but I am not sure that even those tools would get those people into the normal ranges (I’ll let you know when I’ve treated more people.)

    So, in these programs, my friend and others like her would be dinged twice, even when she is doing her best to be healthy. And, even doing her best, she still needs that insurance. Everyone should pay a reasonable amount for insurance without huge penalties, but those of us who choose a healthier lifestyle and still do not fall into the appropriate profile certainly should not be punished. (Not to say unhealthy people should). Gets me riled up.

    • Know what the old (100 years) remedy was for elevated cholesterol? Natural desiccated thyroid. Please read Dr Broda Barnes’s book Hypothyroidism: The Unsuspected Illness. There’s an entire chapter on heart disease.

  13. I have some questions for anyone who is willing to answer. Would you be willing to pay out of pocket for doctor visits if you knew you would be getting quality care, enough time with your physician, and good follow up care? What if you only had Major medical insurance, for a really big medical issue? What if your doctor could control their own prices? What if your doctor could have some autonomy as far as the care you receive individually goes, instead of being forced to follow a formula imposed by the insurance company based on actuarial data? I could see using medical savings accounts for this sort of healthcare style.

    I’d love feedback. Also, an interesting link and something to consider: http://idealmedicalpractices.typepad.com/ideal_medical_practices/2009/02/how-do-doctors-get-paid-.html

    • I’ve seen a number of docs start to go to a system like this and so far it seems to be working for them. I don’t have a whole lot of choice because I make lousy money, so I go where it’s cheapest right now.

    • Actually, this is what the American healthcare system was like in the early 1900s, probably until after the Great Depression. Doctors ran their practices the way veterinarians do today. They had the freedom to control prices as well as their practice, and the AMA lobbied hard against any sort of health insurance, private or public. Eventually, Blue Cross started the first hospital insurance. You could pay a monthly fee to a hospital, and if you ever got sick, you could use it. The hospitals liked this because they had a guaranteed monthly income. When the first insurances started for private practices (not hospitals), it was very difficult to find doctors who were willing to participate. Those who did were shunned by their colleagues, and would lose referrals.

      Eventually it was not primarily the AMA that opposed national health insurance, but the private insurance companies. Private insurance grudgingly permitted Medicare to be passed, because they didn’t want to insure the elderly anyhow. The problem is, in order for Medicare to be passed, the legislation had to be written so that doctors and hospitals had complete autonomy over the prices; they would simply bill Medicare, and Medicare would pay. This resulted in a sharp rise in healthcare costs in the years after Medicare was passed. The prices of things like medical supplies rose sixfold in just a few years. Medicare did eventually impose price controls, but they came too gradually and too late; medical costs had already spiraled out of control.

      What we learned from this is that if the cost of something is not left to the free market, then price controls and restrictions are needed. Insurance companies have guidelines and price controls that doctors have to follow because they need to keep premiums low enough so that customers can afford them. Medicare has the same thing. There is a perceived loss of freedom because of these restrictions, but in reality, very few people could afford to pay for modern medical care out of pocket. Even if medical care were as cheap as veterinary care (which is cheap partially because it was never funded by an unlimited amount of money like human medicine was by Medicare, and also probably because malpractice insurance is much cheaper), it would still not be affordable for some people. Health insurance allows everyone to share the cost of caring for a relatively small number of ill people. Health insurance companies or the government have to make sure that the pool of money is being used properly.

  14. If they implement this at my sister-in-law’s workplace, she’s screwed. She has always been “healthy” (that is, visibly not-fat), but her cholesterol is so bad that she has to take meds just to get down out of the “Agh, you’re gonna keel over” range into the “Really not good, but workable” range.

    I’ve said it before and I’ll say it again: Phrenology is alive and well in a new disguise.

    • Nah, she’ll be fine. If she’s visibly not-fat, then obviously she’s doing all she can to manage her health, poor thing. However, if she gets some health problem that makes her wear a bigger size, she’s in deep trouble.

  15. We are now all witnessing the legitimization of Fat Bigotry by the Industry and by the State. “Wellness programs” are another way of
    legitimizing the bullying of people who do not fit into the a standard one- size for all mind set. Weight and wellness, are two separate issues and it is no one’s business but the individual. How would people feel if the reverse was true and that all very thin people had to get up to a larger size in order to prove they were not bulimic, or anorexic despite their good health? What if everyone was forced to gain weight in order to be considered healthy? What if all men and women were required by their workplace a to go to anger management courses just in case they had trouble with their issues? The list goes on and on, and if this incredibly ridiculous “wellness program” becomes popular with businesses, we are going to see what the book, 1984- was all about- forcing conformity on all.

  16. The more I hear about employee wellness incentives, the more I wonder if fat is one of those issues where logic is pushed aside in favor of handwringing about how it’s So Dire! and There’s No Time To Debate This! so they have to try everything, even things that are harmful, even things that don’t work, because anything is better than being (or staying) fat. I know that fat isn’t the only issue I’ve dealt with where there was similar Abandonment of All Logical Processes In Exchange For Knee-Jerk Reactions and Measures of Questionable Merit, but it’s the one where it’s most obvious that people who seem really smart like medical doctors have decided to instead clutch their pearls and not let go.

    Also, from what I’ve gathered about the efficacy of these wellness programs, actually implementing them is costing companies money since they only barely work, if they work at all. If these programs were employees they’d probably be fired without preamble for having such a shoddy work record. But then saying “These programs only barely work and it’s like they don’t work at all, but we’ll put them in place anyway” is like promoting that employee with the worst possible work performance and attendance record.

    I rambled a little, and I’m sorry. It’s just that the logic of the whole thing gets to me.

    • It’s just that the logic of the whole thing gets to me.

      @Rubyfruit, would that be lack of logic?😉

      • Oh, right! Because employee wellness plans aren’t based on logic, even the ones that would actually help, like smoking cessation plans. If even that doesn’t work long term, and costs companies more money than it would to just not have the program in place, why would they do it anyway?

        Like I said, the so-called logic of employee wellness programs gets to me.

  17. I’m convinced that these ding payments are based on the Islamic model of jizya payments that non-Muslims must pay in order to be allowed to live within those lands. If you don’t pay, you are free game to any gangster or murderer, and your life is forfeit.

    • LOL What?

  18. What can we DO??? They implement this crap based on NO evidence. How can we call them on it?

  19. It’s upsetting that the Affordable Care Act will still continue with these “wellness” intimidation programs. There’s a lot I wish it did differently. However, I personally can’t wait until the Affordable Care Act is enacted. It gives employee’s an option—if your employer engages in these types of programs then there will there will be the option to get Health Insurance through the Healthcare Act. And I know a lot of small business can’t wait to be able to drop the coverage they offer now — and I hope more and more do, we should have single payer system… and the greedy bastards that fight so hard against it will eventually bring about their own downfall.

    And all this “volunteer” stuff is nonsense. There is no way an employee can not “volunteer” for whatever garbage their employer puts forth becasue they’ll suddenly be looked at as a “trouble maker”, “not a team player” and be passed by for promotions, raises and perhaps even fired (of course that won’t be the reason they state–but it’ll be the real one).

    • Just realized I used a gendered slur (along with some careless typos!). I apologize. I’m usually more careful and try to not to use language that may make any person who is part of a marginalized group feel unwelcome and/or contribute to an unsafe place for them to be or participate (myself included). That’s unacceptable fail on my part and I will be more careful in future.

  20. What the fuck happened to patient privacy? I’m too angry to read through everything right now, so if someone already covered this, I apologize for overlooking it.

  21. I do wonder whether these wellness plans might be challenged in those rare jurisdictions where public accommodation statutes forbid discrimination on the basis of weight – there are a handful. However, I have a feeling that federal law would preempt those state statutes or city codes.

    The most recent Hastings Center Report contains a number of replies to Callahan, who you may recall wrote an article justifying stigmatizing fat people in order to address the obesity epidemic (sic). You can find one of the replies at http://ow.ly/lECkL – I think you need journals access to get to the rest. I mention this here because in both the replies to Callahan AND even among detractors of ACA-inspired wellness programs, the underlying assumption seems to be that lack of activity and poor nutrition cause fatness. Obviously this is not the case for everyone, or perhaps even most. But if that’s the underlying assumption, why not have employers make better nutrition (free, tasty, healthful, lunches!) and appropriate, accessible exercise facilities (free swimming pools and softball fields!) available to those who want them? Why not facilitate the behavior, since that is something people can control, rather than penalize people for how they look?

    I think there is a basic misunderstanding of what public health is supposed to accomplish. In my opinion, the responsibility of public health workers is 1) to keep everyone from catching smallpox or typhoid or other nasty contagious diseases, past and present, and 2) change social conditions so that people have increased access to what they need to stay healthy – clean up toxins from the water supply, make sure it’s safe enough for women to go for walks, make sure children get enough to eat, no matter their parents’ income, etc. In neither case is it to institutionalize prejudice and make health care more expensive for people who need it the most.

  22. My job is contractual through the state of Maryland, which means I only get paid for the days I work and I have no benefits, so I pay for my own health insurance. Because traditional insurance refuses to carry me based on the Bullshit Mass Index, the only plan I could get was through the state’s high risk pool. I belong to a special plan based on low-income. Last month I was informed my insurance will cease to exist in December and to apply for insurance through the Affordable Health Care Act. While I know they can’t deny based on pre-existing conditions, I’m worried since this administration is so anti-fat and refuses to see the evidence that all fat people aren’t walking deathbombs, I fear this insurance will be all wellness and weight-focus based. But since I don’t have workplace coverage, I may just fare better than those who are insured by their employers. I can only hope.

  23. The erroneous assumption underlying all of these “wellness” programs is that we can all somehow control our health outcomes by changing our behavior. It assumes that all illness is preventable. Can I say that this is out and out crap? I’ve been an RN for almost 30 years, and I’ve seen “healthy” people become ill, and supposed “unhealthy” folks live into their 90s. I’m not saying that there isn’t anything we can do to help improve certain symptoms or disorders, but there are no guarantees. What works for one may not work for another. You also cannot avoid the effects of aging. Things will start to break down, no matter what you do. You cannot apply any strict formulas to our amazing bodies, which are more complicated than we will probably ever know.

    And don’t get me started on patient privacy problems…..

    • I KNOW! The idea that we have that much control is ludicrous, but people still believe it.

  24. What with the economy, my various health conditions, and now this BS, I’m scared to graduate from college. I’ll be out next spring. The degree program I’m in (environmental science and resource management, aka ESRM) is very proactive about finding and presenting job options to students at my school, but I’m not the typical ESRM graduate. It’ll be hard enough making a living wage with my medical costs- and even with insurance, my medication copays take a hefty bite out of my budget- even without this “wellness” crap. If I let anyone connected to my theoretical job have access to my medical records, they’d find out I’m bipolar. I do NOT want even the slightest chance of my boss knowing that about me. They’d find a legal reason to get rid of me, probably the “not a good fit for the team” schtick.

  25. I’m hoping for a torrent of lawsuits. In a courtroom you need to present evidence not fear-mongering and folklore. I’m still waiting to see the evidence that significant long term weight loss is possible AND necessary. I feel one problem with the discourse about fatness and health dollars is that the burden keeps landing on us to disprove a negative and it should be very much the reverse.

  26. Thanks for the heads up and the great info, Ragen.

    I’m having a hard time swallowing this insanity, as I’m sure others are as well. It’s really hard to believe that any of this can be legal. I’m starting to wonder how much farther they can push us before the sane people raise up and push back.

    I see people, like you, pushing back and raising awareness, and am so thankful for your heart and spirit! Thank you for this blog and your hard work! You are awesome!

  27. Why the heck to people not fight stuff like this, yet freak out at the idea of ‘socialized medicine?’

    • Because people are not a monolithic group and there are many individuals and groups working for social justice which includes comprehensive health care and access to such care. Also, an individual of a marginalized group is not tasked with fixing nor are responsible for the systemic systems of oppression used against them.

    • This is exactly WHY I freak out at the idea of “socialized medicine.” I don’t want the government to have even more power than it already does.

      I’m a Libertarian. I want freedom, and the more control we give the government, the more power they have to oppress people.

    • Because it’s wrong for the government to regulate the private lives of citizens, but perfectly okay for private corporations to do it. ///sarcasm.

  28. My husband’s employer (a VERY large national company with thousands of employees) forced everyone to have a health examination earlier this year… if you didn’t get it done they were going to charge an extra thirty dollars a month for each of us. They also introduced a fairly hefty penalty for smokers. I’m just waiting for them to double the cost of our premium for DH and I having the temerity to both be fat.

  29. I am wondering how these possible / probable insurance penalties will work with obesity now having been declared “a disease.” One of the clauses of the Affordable Health Care Act–I thought–was that consumers could NOT be charged increased premiums due to illnesses or pre-existing conditions. Anyone have any ideas or info on how this will shake out?


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