Pudge Police Coming — Part Two

Part One here.

North Carolina legislators voted to use discrimination to help bail out the State’s Health Plan. As troubling as that sounds, the legislation passed without much trouble, perhaps because it’s been easy to convince the public that certain people are costing them and to blame for having health problems.

Last week, the North Carolina State Auditor’s Office released its audit of the State Health Plan, entitled Performance Audit, NC State Health Plan FY 2008 Projected vs. Actual Results. The Beaufort Observer editors summed it up: “It is disgusting, to say the least.”

“The bureaucrats’ math in doing the projections was off by $137.6 million,” they reported. The state had signed a contract with Blue Cross and Blue Shield for a managed PPO type of plan (Preferred Provider Organization) with its “North Carolina HealthSmart wellness programs” that were supposed to make the state money ($57.9 million). As we know, these health management plans — focused on preventive wellness, risk assessments [risk factors do not mean risk] and disease management using their clinical guidelines; and with providers working under P4P (pay-for-performance) mandates — have not been shown to improve people’s health outcomes and have been shown to actually cost more and raise administrative costs.

Sure enough, the plan lost $79.7 million last year.

As the Business Journal explained, “increased claims and administrative expenses cost $200.1 million more than planned, wiping out $62.5 million in revenue over budget.” The PPO plan, started in 2006, was marketed as being less expensive because of discounts negotiated with providers. But as more State Health Plan members enrolled in the PPO plan, they used more medical services. The legislators who had instituted the State Health Plan’s contract with BCBS had also underestimated administrative expenses by $36.3 million. North Carolina’s General Assembly has had to dip into the state’s reserve funds to cover the plan’s growing losses, said the paper.

Last week, as the Sun News revealed, one of the ways the state has responded to its public health insurance boondoggle is a proposal to “peg the state’s funding for local health departments on benchmarks local officials say they can't control.” Brunswick Health Director Don Yousey explained that the state now plans to tie local public healthcare funding to each county’s incidences of tobacco use, obesity and diabetes. In other words, if there are more fat people, smokers or diabetics in a given county than the state allows, funding would be withheld.

How welcome in their communities do you think people with these risk factors will become, as local governments see them taking money from their coffers? Medical professionals know that the people who will be most targeted will be the aging, those with certain inherited traits and those of lower social-economic status. These are the people increasingly seen as less deserving of healthcare because of myths that any health problems they have are self-induced and were preventable.

The legislators had not consulted commissioners from the health department, the Sun News reported. Commissioners said they are concerned that linking funding to certain benchmarks will have the same outcomes the last time the government tried that with mental health services: patients have been forced away from local care to large regional state treatment facilities, and those who need care have not been able to get it.

The second half of the discrimination equation being used to try to bail out the state budget has already been activated. The News Observer reported that legislators recently adopted its State Health Plan bailout bill. It calls for specific “wellness provisions” that will, for instance, charge fat people and smokers more by forcing them into more expensive insurance plans. “The first step in the wellness program is to shift every State Health Plan enrollee into the most expensive insurance coverage option — the so-called ‘basic plan,’” said Adam Linker, with the N.C. Justice Center’s Health Access Coalition. “The burden of proof is then on the employees to verify that they, and all of their family members, are properly proportioned nonsmokers.”

Verification in hand, employees then earn the right to move back to the less expensive insurance coverage option known as the "standard plan." This is an administrative train wreck waiting to happen. The insurance enrollment process is confusing and chaotic enough without juggling families back and forth between health plans. But let's suspend disbelief for a moment and assume that administration and enrollment go smoothly….

[T]o ensure that none of those crafty state employees tries to sneak a cigarette, the State Health Plan will subject all enrollees to random blood and breathalyzer tests. Plan officials will conduct the random tests… The bill also authorizes plan officials to dream up additional punishments for employees caught lying about their smoking status. In 2011 the State Health Plan will institute a similar program to punish those with body mass indexes, in the words of the bill, “within a range determined by the Plan” based on undefined “clinical guidelines.”

Think about that for a moment. In order to receive affordable health care paid by the government, the State will force you to submit to blood, urine and breath tests to measure your health indices and monitor your compliance with what it determines best.

North Carolina is following the example of the Japanese government and its health ministry’s compulsory blood tests and “flab checks” for older workers, with BCBS taking the lead to impose similar mandates here. Japan’s mandatory health assessments were purportedly to identify those with metabolic syndrome (“metabo”) and charge stiff penalties to those who fail to conform, most notably older and naturally heavier people. More than half of all adults will be hit with penalties under Japan’s metabo campaign, which is said to really be part of efforts to shift costs of Japan’s failing government health care program to the private sector.

As we’ve seen, the preponderance of sound medical evidence and objective population data continues to show that these health indices are not measures of health or risks for chronic disease (from diabetes, cancers to heart disease) or premature death. Nor are they measures of those eating right, exercising or following healthy lifestyles.

No body measurement is. Instead, they are primarily indicators of aging, as well as genetics and social disadvantage, and hence discriminatory.

Today’s intense marketing of lifestyle medicine and preventive wellness has popularized beliefs that chronic diseases are people’s own fault and could have been prevented by 'healthy' diets (defined differently depending on the source) and lifestyles. The results of every major randomized, controlled clinical trial of healthy eating and lifestyles to date, however, have failed to demonstrate credible benefit in preventing chronic diseases of old age (like the big three diabetes, heart disease or cancers) or in living longer. Nor has any healthy eating intervention been shown to give everyone a government-approved BMI.

Achieving and maintaining the low metabo numbers now being required by third-party payers can only be achieved by profitable prescription medications, for nearly all older adults, and increasingly radical weight loss measures, none of which have ever been proven to improve actual health outcomes, but to put people at increased risks.

The only way that lifestyle medicine has been able to achieve such popularity and why these compulsory interventions and penalties aren’t immediately apparent to everyone as discriminatory, is because of today’s widespread lack of scientific literacy. That’s simply how to think and reason logically.

Such discrimination can be made to seem appropriate when society has a poor understanding of science and credible information, and when it comes to believe that certain people are less deserving of healthcare.

As the paper points out, no other state has such far-reaching “wellness initiatives” and Alabama has the only law on its books charging a fee for obesity. This will only hurt people — fat, elderly and poor people most of all. “Health researchers know that if a state employee is suddenly required to pay steeper deductibles it will likely deter him from seeking needed medical care,” Linker pointed out, adding:

State Health Plan officials and legislators claim they want to save money and improve the lives of state employees by showing them tough love. The problem is that state actuaries have not predicted any savings from these ill-defined wellness programs.

Even under the rosy assumptions presented by the plan’s director, they might only break even in three years, he wrote. But that’s not likely to happen, either, because these wellness programs aren’t based on sound science to begin with and have never been shown to improve actual health outcomes or reduce healthcare costs.

Had Joseph Goebbels, in the 1920s, correctly pegged people as easily manipulated by media disinformation campaigns, groupthink and fallacies of logic? Without an understanding of sound science, discrimination can be made to seem acceptable and “for their own good” … and for the greater public good. Societies have been down this road before, with tragic consequences for humanity. People didn’t see then until was too late. That’s why science is more important than ever today.

© 2009 Sandy Szwarc