Club Soda and Salt

No more stains

Demonizing Incentives

Posted by clubsodaandsalt on October 26, 2005

So I suppose the point of this article in the Times is supposed to be that Walmart is totally evil, becaue they’re trying to find ways to cut their benefit costs. I just don’t buy that, though. An explanation why after the jump…

While I hate Walmart and what the generally stand for, this is just standard issue cost-control, and it’s cost control that’s made necessary by how idiotic the health care system is in this country. What Walmart has done here is put into leaked-memo form what companies all over America are desperately trying to do — get healthier workers.

Go into any large company’s office, and you’ll see all sorts of “Be Healthier!” paraphenalia. I’ve eaten in a few different corporate cafeterias, and the pamphlets and such are pretty ubiquitous there, as well. And while I haven’t personally witnessed this, I bet there are many companies that tell interviewers to screen for obesity and general well-being (especially for unskilled positions.)

And it’s not just employers. Because we have a high-cost and (mostly) for-profit system, insurers also desperately try to pass the buck. If you are overweight, in poor health, in a rural community, or work near a hospital, health insurers are trying desperately to lose your business. And why shouldn’t they? Why is your health some insurer’s responsibility?

What amazes me is that anyone should be able to look around and see that the system is a giant failure. No-one even makes any money! Hospitals and health insurance companies are dismal financial performers, and employers are beginning to balk at rising costs. Meanwhile, Americans are less satisfied with their level of care than any number of Europeans, who spend way less. So. What to do?

Well, more government involvement would be nice. Medicaid and Medicare have issues, obviously, but they are far more efficient than their private counterparts, largely because scale means very very low admin costs. The involvement of private insurers only serves to reduce scale and add paperwork. That’s not the whole answer, though. People need to have a better sense of the cost attached to their care, so that health care can be more like a real “market”, with higher and lower cost options. Perhaps most importantly, doctors and insurance companies need to be made to get off of their asses and discover “computers” and “the internet”. Every time I visit a doctor, I am APPALLED at the rudimentary record keeping at most offices. In any other industry, keeping all your work on paper would mean overnight obselesence. Why should doctors get a pass? Let’s cut costs by making things electronic!

There are lots of other great ideas floating around out there, and I just wish people would get over their libertarian ideals and American exceptionalism and stop pretending that American health care isn’t a major fucking embarassment. And I also wish we wouldn’t all be so tempted to use Walmart as a scapegoat while ignoring the larger problem.


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