Over at The Juggle, Sue Shellenbarger examines the increasing tendency of employers to attempt to control health care costs by encouraging behavior and life-style changes on the part of employees and their families. I think this is inevitable, but it opens up a slew of ethical issues. Do we really want our employers trying to influence how we eat, exercise,and spend our free time? On the other hand, do we give up the right to complain when we expect them to pay for our health problems, even those that are self-induced? Where do we want to draw the lines regarding what is acceptable employer interference among such measures as…
- incentives for the employee to lose weight and exercise
- incentives for the exercise to involve safer activities (the treadmill and stationary bike) rather than riskier ones or exercise that is punishing on the body (X-treme skiing; super-marathons)
- incentives for spouses and children
- monitoring of unhealthy activities like smoking, drinking, and recreational drug among family members
- monitoring of unhealthy activities like excessive computer use, videogaming, and gambling
- institution of stress reduction, anger management and psychological health measures among family members
- family planning instruction to limit the number of pregnancies
- encouraging abortion when indications are that a child will have serious health problems
…and more. If you find these intrusions tolerable, will you feel similarly if the government is the one giving incentives, positive and negative, to encourage healthier conduct by member of your family? How long will we agree that all individuals should pay the same for workplace health insurance regardless of predictable genetic, actuarial and demographic factors, when cultural, personal and family activities are being monitored and penalized?
The unspoken dilemma that lies in the shadows of the health care debate is that autonomy and freedom are not compatible with dependency and shared costs. You can scream that it is outrageous for our mutual employer to demand that your kids lose weight and substitute jumping jacks for their rock-climbing, but when I have to start paying extra for your risky choices, I may find myself on the employer’s side. We are being slowly forced to confront an ethical dilemma pitting health and economics against autonomy and freedom, and the ethical course is anything but clear.