"Personal responsibility" is a politically loaded term. In the context of health care, Democrats accuse Republicans of using it to resist the expansion of insurance benefits, while Republicans counter that making comprehensive health insurance mandatory is paternalistic and potentially unaffordable for many people compared to other less costly options. While the fate of the different health reform blueprints recently passed by the Democrat-controlled House and the Senate remains uncertain, I think it's worthwhile to look at other innovative models of financing health care. You might be surprised to learn that two national grocery chains - Whole Foods and Safeway - are right on the cutting edge.
In August 2009, Whole Foods CEO John Mackey stirred up a small controversy by writing in a Wall Street Journal editorial titled "The Whole Foods Alternative to ObamaCare" (though Mackey later stated on his blog that the newspaper editor was wholly responsible for the provocative title) that his company's high-deductible health insurance plan was superior to both the typical employer-provided insurance model as well as government-sponsored insurance plans then under consideration by Congress. How does the Whole Foods plan work? Employees receive up to $1,800 yearly to deposit into a personal health savings account, which they can spend any way they like, paying full price for all medical services. If an employee's yearly health expenses exceed $2,500, catastrophic health insurance coverage kicks in. The lower premiums allow Whole Foods to provide insurance to more employees at lower cost, and employees pay only for the health care they need, rather than the health care that they might need. Personal responsibility in action.
Safeway has taken the philosophy of encouraging its employees to make intelligent health choices to another level. Based on the principle that the majority of health care expenses result from unhealthy behaviors such as phyiscal inactivity, poor diet, and smoking, in 2005 Safeway began offering insurance premium discounts of up to 50 percent to employees who passed a nicotine screening test and achieve weight, blood pressure, and cholesterol goals. Although the program is voluntary, enough employees have joined in that Safeway's obesity and smoking rates are now 70 percent of the national average and their per capita health care costs have not increased for the past 4 years, according to Safeway CEO Steve Burd.
It's not clear if either the Whole Foods or the Safeway insurance plans will survive health care reform unscathed; the Whole Foods plan, after all, is based on catastrophic insurance, which could be erased by any reform bill that requires comprehensive coverage for all eligible persons. And some argue that imposing financial penalties for lifestyle choices is tantamount to discrimination. But both of these examples tell me that personal responsibility for one's health may be one of the missing ingredients in the current conversation on reform.