We all want to be healthy. No one wants to drop dead of a heart attack prematurely or have our lifestyle ruined by one of the many unpleasant complications of diabetes. And it's equally natural that the companies that employ us want us to be healthy and productive. But just where do we draw the line between these laudable goals, and the steps that companies take to deliver them? When does an incentive become an intrusion into one's personal life - an intrusion designed more to maximize a company's financial health than the employee's physical wellbeing?
The proliferation of "wearables" - devices that, as the moniker suggests, we can wear and that can track everything from how much and how vigorously we move to our blood pressure - should be prompting even more of a discussion than they are about just when an employer crosses the line and becomes a Big Brother.
Even before the advent of the Fitbit wristbands - and now the brand-new Apple Watch, which will offer users, and their employers, access to a host of brand-new healthcare apps - the measures that companies took to prod their workers to get and stay healthy sometimes became controversial.
Some, like the Cleveland Clinic, were overt, linking employee behavior to small financial incentives and much bigger penalties. In 2012, it announced that any employee who was overweight or who had other risk factors (who smoked, had asthma or high blood pressure) and who didn't join a company wellness program, would face a 21% hike in their health insurance premiums. Even if they did join the program, but didn't meet the goals set for them by the administrators of that program, their rates would still rise by 9%. Only if they met those goals would they belong to the "Gold" group, and see a small financial benefit - in addition, of course, to any personal health benefits.
Others went a step further. Pennsylvania State University launched a wellness plan in 2013 requiring professors and other non-union employees to get checkups and also to fill out a health risk questionnaire. Questions included whether they had recently divorced, or recently had problems with a co-worker, while women were asked whether or not they planned to become pregnant. Anyone refusing to complete the form would be fined $100 a month. After a furious protest, the school scrapped the plan.
About a third of all employees who enroll in company healthcare plans now may be asked to fill out this kind of questionnaire, according to calculations by the Kaiser Family Foundation. Don't want to tell your boss whether you have a social group (lack of one might be a warning signal that you're about to cost them a lot in counseling fees due to depression) or how many alcoholic drinks you consume? Well, tough.
The good news is that the law states that employers can only use this information to design wellness programs, and if you're fired after disclosing you have some kind of condition that might drive up your company's health costs, well, you may have a great lawsuit, too. The bad news? It could be tricky to prove that "cause and effect" link in a court. Then, too, it's not just about what happens to the information that you provide, but the process of providing it.
The pressure to sign up
Which brings us to the apps. In this era of wearable technology, employers conceivably could monitor everything from our blood pressure and pulse, to how many steps we take throughout the day. Your Jawbone could monitor how much you sweat, your body temperature and your activity level - and prod you to exercise more if you're not doing a good enough job, via a remote coach. Even if programs remain optional, opting out is likely to be greeted with wariness, much like a suspect's refusal to provide DNA or fingerprints might be after he has insisted he isn't guilty of whatever crime has been committed.
It's clear that the employer market is a primary target for companies like Fitbit, Jawbone UP and now Apple, with Apple Watch. BP America bought 24,000 Fitbits to hand out to employees, their spouses and retirees in 2013.
That paid off for the energy giant, which saw the growth rate in the company's healthcare expenses fall to below-average levels. It can also reap dividends for employees. Bates College, in Lewiston, Maine, noted that the most active employees wearing fitness trackers lost as much as 5% of their body weight in the first two weeks of the new wellness program last year.
But a lot of these programs have an elementary school competition feel about them. Those who do well at the Bates College program get stickers that in turn entitle them to discounts at the school's salad bar. Many workplaces urge colleagues to compete with each other and to share information about their exercise activities, even getting them to form teams.
Measuring financial and health benefits
The challenge will be for employers and employees to find a way to maximize the financial benefits to one, and the health benefits to the other, without employees feeling that they are being supervised and manipulated. In a world where employers can read our email, monitor how long we spend away from our keyboards and conduct extensive background checks, do we want to give them data on how well we're sleeping, too? Even if it's being collected and held behind a firewall?
Meanwhile, there are plenty of simpler steps that employers can take to encourage us to get healthy. The bonus is that these don't have some of the bugs that still afflict wearable technology, from battery woes to wildly varying results (depending on which device you use).
Start with cafeteria food. Employers, in a bid to cut costs, often go for the cheap route here, and that all too often means less healthy options are the most readily available. Ban fatty and sugary foods, make nutritious and filling meals available at an affordable price, and that will reap dividends without being intrusive.
Pay the full price for employee gym memberships, or provide an employee fitness facility - no questions asked. That's one way the Cleveland Clinic's program worked well, by making those fitness programs accessible to everyone, and making them free to anyone who used them with a certain frequency.
Make it easier for employees to exercise. That could mean providing showers for anyone who bikes to work, giving us an hour off in the middle of the afternoon to hit the gym (instead of insisting that we squeeze it into the time we have available after we finish work at 7pm or later, sometimes when gyms are most crowded or may even be closed), or making treadmill desks available in the office. And what could encourage wellness more than not making it difficult for employees to take time off for doctor's appointments, or to stay home when they have the flu? (I'll never forget the infected tooth that turned into an abscess when my new boss insisted that I couldn't have time off to see a dentist.) And what's a better stress buster than a vacation? American employers are already notoriously chintzy when it comes to paid holidays, but one survey shows that as many as 42% of those entitled to at least 10 paid vacation days last year didn't use a single one.
None of those, of course, have the buzz and cachet of the latest technological gizmos. But nor do they run the risk of invading your privacy, as do about three-quarters of the healthcare apps surveyed by the Privacy Rights Clearinghouse two years ago.
But tech is determined to invade healthcare and employers always want to save costs. In the meantime employees need to make sure they are getting the benefits - and not just the costs - of our changing world.