Why Health Insurance Doesn’t Work

How will you be able to monitor that, and what do you say to people who say that you're turning into a version of the food police or Big Brother?
We have a third-party administrator, so all the information is kept confidential.  That information is kept behind a HIPAA firewall.  We don't want you to have any reason not to do the preventive stuff, so that is paid for 100 percent.  But if you don't take advantage of that, then your premium will go up. 

In some insurance companies, smokers already pay a higher premium today.  And the average smoker costs about $1,500 per year more.  Individual responsibility is important.  It's not fair for people with good, healthy behaviors to be subsidizing people with poor behaviors.  

What kind of response have you gotten?  
In the first year, about 45 percent of our eligible employees signed up.  In the second year, it was 71 percent  The only other alternative plan people can choose from is an HMO, which has none of these behavior characteristics—you sign up and they take care of all your health care. The cost of that plan actually went up 8 percent last year.  And I believe the cost of that plan will go up again.

So you're talking about universal coverage but not single-payer universal coverage?
That's correct.  Sen. Ron Wyden from Oregon and Gov. Arnold Schwarzenegger from California advocate an individual mandate following the model of the automobile insurance industry.  In California, for example, you have to buy liability insurance to drive a car, but you can buy it from many different companies.

In summary, you're saying that prevention is more cost effective than managed care because it addresses the more fundamental causes of health and illness.  
Yes.  Your preventive message has been influential on Safeway's health-care design in collaboration with our work with Cigna.  The cornerstone of that design is really prevention and behavior, which is what you've been preaching for 30 years.

Besides helping our employees to stay healthy, we're helping our customers identify foods that are particularly healthy for them to eat.  Some of the healthiest foods are unbranded fruits and vegetables, so we've put signs in our produce section with notes from you, such as, "Did you know that these tomatoes are high in lycopene, which may reduce your risk of breast cancer and prostate cancer?"  "Did you know that these blueberries may improve your memory?"  You're our field guide.  I envision a day when insurance companies give families discounts on their insurance for eating healthier foods.

There's no question that this problem is going to get solved if we address the root causes.  Rarely in a lifetime does a problem this big, this complex, surface that you can sit around a water cooler and say: you know, we can solve this one.  Prevention and behavior matter.  They are the Holy Grail of a health-care solution.

© 2007