Friday, May 15, 2015

Genetic Testing In Corporate Wellness Programs?

Fox News in New York issued an interesting report stating that US-based Aetna Insurance and Newtopia, a Canadian company, are working to prove that genetic testing can reduce medical costs to employers, so that they can sell that as part of corporate wellness programs.
Sparking the push to add genetic testing into corporate wellness offerings is a new program from the health insurer Aetna and Newtopia, a small Canadian company that creates personalized health-improvement programs. Their offering uses data from initial wellness program steps like physicals or blood tests to figure out which employees are vulnerable to metabolic syndrome.

That's a group of conditions like high blood sugar, poor cholesterol or a big waistline that, when they occur together, increase a patient's risk for heart disease, stroke and diabetes.
This prompts speculation that companies will genetically screen employees as part of the employment screening process.
In fact, corporations are looking to new genetic testing programs to see if they can predict the probability of disease in future employees. The technology is said to help companies avoid hiring employees who take extra sick time and is supposed to help the companies cut down health expenses altogether.
Wellness programs are sold on the basis that they save employers money.  I've never kept it secret that I'm skeptical of these programs, but to say that at work is to confess to eating babies or something awful.  In reality, employers can push workers harder if the workers can take it.  If they keep having to replace workers who crack under the stress, they don't get the work done.  But there's a really simple solution to reducing the cost impact to corporations:  get them out of the health insurance business.  Make health insurance like car insurance or any other insurance.  Get the government out of health insurance.  That makes it more competitive, and more market based, especially if the byzantine rules that keep you from buying across state lines are gone.  People can buy their own car insurance, is that all that much simpler than health insurance?

Regardless of whether companies are going to start genetic screening, or if that's just wild speculation, it's been my contention for some time that the conventional full time work that we're used to is going away and will likely be gone within the lifetimes of people reading this today, if the trends continue.  The reason is the same: government over-regulation.  The pressure from these rules will help force work relationships to be more independent contractors and far fewer full time employees.  I work for a very large company, so we're not going to be 100% contractors anytime soon, but for new, start-up companies, the barriers being constructed are going to prevent them from growing beyond 50 people (the current number).  The cost of keeping up with new laws and regulations is simply too high.  As Elizabeth MacDonald at Fox Business News put it, "The government, in a sense, does create jobs in the private sector—a massive vegetative, unproductive universe of workers dedicated to dealing with federal rules."

There was a report this week from the Competitive Enterprise Institute showing that the cost of regulations took $1.88 Trillion away from productive uses in our economy.  If U.S. federal regulation was a country, it would be the world’s 10th largest economy, ranked behind Russia and ahead of India. Regulation nation is bigger than Canada.  Their report, with the wonderful title, "Ten Thousand Commandments" lists some memorable facts:
  • Economy-wide regulatory costs amount to an average of $14,976 per household – around 29 percent of an average family budget of $51,100. Although not paid directly by individuals, this “cost” of regulation exceeds the amount an average family spends on health care, food and transportation.
  • The “Unconstitutionality Index” is the ratio of regulations issued by unelected agency officials compared to legislation enacted by Congress in a given year. In 2014, agencies issued 16 new regulations for every law—that’s 3,554 new regulations compared to 224 new laws.
  • Some 60 federal departments, agencies and commissions have 3,415 regulations in development at various stages in the pipeline. The top six federal rulemaking agencies account for 48 percent of all federal regulations. These are the Departments of the Treasury, Commerce, Interior, Health and Human Services and Transportation and the Environmental Protection Agency.
  • The 2014 Federal Register contains 77,687 pages, the sixth highest page count in its history. Among the six all-time-high Federal Register total page counts, five occurred under President Obama.
  • The George W. Bush administra­tion averaged 62 major regulations annually over eight years, while the Obama administration has averaged 81 major regulations annually over six years.
For years, I've been arguing we need to start pruning the Code of Federal Regulations back.  There's a "Regulatory Improvement Act" already in process that would establish a Commission to comb through the Code of Federal Regulations, now 175,268 pages long, and look for harmful, redundant or outdated regulations to get rid of.   That will address the monster we have, adding automatic sunsets or expiration dates for new regulations would help keep the monster from growing as much.  For starters, all new laws would expire after a period time, for example, five years.  Automatic expiration provides a painless way to get rid of obsolete or ineffective rules, and still allows Congress to easily renew successful regulations with a vote.


  1. Let's not just start with 'new' laws that would expire in 5 years.

    Put a 5 year expiration on every U.S. statute on the books and the regulations and agencies that proceeded from them.

    Make it mandatory that each law go through the complete committee and mark-up process, not just be reinstated by some omnibus act.

    People might say that this would take up to much of Congress' time, but I say good.

  2. Color me paranoid, but I have refused to participate in the "preventative" health screening offered by my medical insurance company, even though they offer a cash reward for doing so. I'm concerned that by doing so I might end up with the insurer denying coverage if I don't lose a set amount of weight, or decrease my coronary risk numbers (cholesterol, LDL, HDL, etc.) by eating a diet that is unpalatable to me (like no butter, less meat).

    Yes, they get the information from my labs and MD's charting, but I have not agreed to modify my life-style by choosing to participate in their programs, nor have I accepted their monetary inducement.

  3. Genetic testing for "wellness" is referring to the financial 'wellness' of the insurer, usually an employer. It ALWAYS means that such testing, when it identifies a genetic marker indicating someone is at higher risk for specific disease(s) or problems, will result either in denial of coverage, denial of coverage for specific diseases or increased premiums for the insured. Basically genetic testing is not about providing for the health and well being of the insured but about protecting the financial interest of the insurer.

    This means that a useful tool that could make people healthier is perverted for financial gain so
    The people whom might benefit will avoid this potential help due to fear they will lose or be denied coverage. That's how insurers work. They do not want to cover people who may actually need coverage. They will, when allowed, cherry pick whom they cover land offer policies ONLY
    to those they believe will not use the coverage.
    It's a racket. A legal form of theft as the insurer always seeks to deny paying for a claim but ALWAYS insists on being paid. If you aren't savvy to how they work they will screw it car I durance, home owners insurance or health insurance. Just like casinos don't build those huge fancy palaces on the strip by paying gambling winners insurance companies don't build 50 story buildings and pay their officers multi million dollar salaries by paying claims. They only payifnthey can't find an excuse to not pay....and even then they drag their feet and pay for substandard work.

  4. There is a persistent belief in some health care circles that long life and good health can be achieved with a handful or measures: regular excercise, healthy eating (that no ne can agree on what that is or is not) and regular specific tests (such as mamograms).
    Part of what makes this a popular belief is that for certain diseases, such as diabetes for example, intensive monitoring and treatment does indeed lead to positive outcomes. What is missing is if you do not have genetic illnesses or genetic predisposition to illnesses (like diabetes, heart disease, certain cancers, etc.) that no amount of intensive monitoring, testing and treatment will make you live longer or disease free. Simple as that! If your genes are good you will probably live into your 80s with or without medical care and with or without healthy eating and excercise. If your genes predict you will have one of the many genetic diseases then by all means seek good health care and follow your doctors advice and you too may well live into your 80's.
    There is no magic food, no magic prescription, no magic! There are things out there to avoid: drugs, alcohol, gross overweight to obesity and fad diets. Other than that the best advice for a long and healthy life is to choose your parents well.


  5. What about the Genetic Information Nondiscrimination Act?


    How well will it be enforced?

  6. Lots of great comments. As you might imagine from my dim view of wellness programs in general, I'm with RegT, Anon@11:25AM, and, really, all of you.

    My employer makes participating in the program mandatory, but in a way that isn't really punishment. They pay you a cash incentive if you meet some arbitrary and changing goals. Personally, I don't care if they pay me or not (aside from who doesn't like $1000 of "free money"). I don't care what they say I should do or how I should behave. They run weight loss competitions and such nonsense. I have better things to do with my time.

    A major industrial company, Honeywell, was sued by the EEOC for discrimination in their wellness program. They charged a penalty if you didn't meet these arbitrary goals, and the EEOC charged they violated both the Americans With Disabilities Act and the Genetic Information Nondiscrimination Act. A court ruled in their favor, saying Honeywell could continue to charge employees $1500 a year ($2500 for smokers) if they refused to get blood tested.

    Now that smacks of the kind of totalitarian nightmare everyone talks about.

  7. There is a big difference between car insurance and health insurance; car insurance only covers catastrophic events and at its most basic covers what you do to others (liability) and does not cover routine maintenance.
    Health insurance is cost sharing - it covers routine maintenance (preventative care) as well as catastrophic coverage. The old, and now vilified, cheap catastrophic policies were much more like car insurance. One reason they were cheap was how much less they covered, often only starting to provide coverage after a personal or family outlay of $5,000 or $8,000 per year.

  8. Jonathon H - that's one of the biggest problems. You wouldn't use your car insurance for a routine oil change, so why use insurance for a routine office visit, or for minor illnesses? Yet because of the system that's in place, most doctors will refuse to see if you if you don't produce that card.

    This is where government "effed" up everything, as they always do. Everyone who thought they had a illness that was ignored lobbied the gubmint to pass a law mandating it get added to insurance. With the passage of Obamacare, we're now legally forbidden to specify a policy that doesn't include maternity, drug addiction and other things. My wife and I are over 60; what are the chances I'm going to need to maternity coverage? I have a drink once or twice a year, and don't use any drugs; I think the chances I'll need addiction coverage are just about 0.00000. But I'm required to have them so the money is there to pay for the people that do.

    You could argue that maternity coverage for a normal delivery shouldn't exist - and, yes, I used it when my kids were born. Today, delivering a child is almost scheduled. It's certainly almost always planned. Why should medical insurance be needed? The ugly underbelly of insurance is that it drives up costs.

    The only way insurance can work is if they take in more money than they pay out. I don't have any problem with them taking a few percent off the top to pay for administering it. As long as people keep demanding things be covered by insurance and keep getting the Feds to do more, the situation will get worse.

  9. Insurance is a funny thing and not what most of us think it is. Insurance is a mathematical bet not so different from playing 21 or craps. Most of us think of insurance (especially health insurance) as a benevolent gift. We have to pay for it of course and we think that is because of "greedy insurance companies" or something. But it is pure math plus 10% or so to cover overhead and keep investors. If you purchase a health insurance that requires a "family outlay of $5,000 or $8,000 per year" you are getting exactly what you paid for (minus 10% or so). Health care is expensive thus health insurance is expensive. Simple as that.