When Ron Sims first announced six years ago that King County workers would have to shape up or pay up, his idea was denounced by some as the "wellness police" run amok.
When Ron Sims first announced six years ago that King County workers would have to shape up or pay up, his idea was denounced by some as the “wellness police” run amok.
“Mind your own business; my health is between me, my family and my doctor,” wrote one county employee.
Sims’ plan “combines the intrusive nanny-state with ineffectual government where nobody is accountable for results,” wrote Seattle conservative blogger Stefan Sharkansky, in 2005. “Don’t expect the county’s ballooning health care bill to deflate any time soon.”
The exact same naysaying is going on right now in Chicago. The mayor there, Rahm Emanuel, announced two weeks ago that city employees will have to enroll in a King County-style wellness program, or pay an extra $50-a-month insurance premium. Notably, the police union refused.
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An online poll on the NBC Chicago website revealed 68 percent of respondents to be “furious.”
“It’s health fascism,” wrote a commenter “This is what’s coming for all under Obamacare.”
Well, no, not exactly. But maybe it ought to be.
As we know now, King County’s ballooning health-care bill did deflate. The county’s health-care costs are still rising, but much slower than predicted — about $60 million slower than projected for just this year and next.
How did Ron Sims, the former King County executive who was wrong about some things and controversial about everything, get this one so right? More importantly, why isn’t everybody copying it now?
Though Sims was called a nanny-state socialist, what he actually was trying to do was bring the free market back into health care.
“The real problem is, normal market forces do not operate in health care,” Sims said in a speech about this in 2006. “It’s basic economics. Employees choose whatever care they need or want, providers deliver whatever care they deem necessary, and the bill gets paid by a disengaged third party. It is a deeply flawed system.”
King County tried to fix it in two ways. One, it tied workers’ insurance costs to their health habits (they can get up to $1,500 a year per family if they sign up for a wellness program with some health coaching). Two, it turned patients into consumers by having them pay only co-pays and deductibles. There are no monthly insurance premiums.
The first plank is to get workers to take more responsibility for their own health. The second is to get them to be more vigilant about their health spending. Personal responsibility, market vigilance — these are supposedly the Republican prescriptions for fixing the health-care mess.
Yet because they were implemented by Ron Sims, with the support of the public-sector unions, they were bashed at the time as Big Brother.
Well anyway, now that they appear to be working, why not copy them?
Plenty of private companies have wellness programs, and about a third offer financial incentives to join. Others try to give workers a financial stake in their own health care using health savings accounts.
The national health-care reform act also includes some grants to help companies do wellness programs. It doesn’t require them.
But Brooke Bascom, of King County’s health reform group, said she knows of no other government body around here that has tied the idea of getting healthier directly to the employees’ out-of-pocket expenses, as King County has. “It’s very hard to put one of these programs in,” she said. “The first reaction is ‘No, I’m not going to do that.’ A lot of people misinterpreted ours from the start.”
Maybe that’s because what King County did was “a curious Seattle stew,” wrote The Seattle Times’ Richard Seven in 2006. It combined “the stark but in vogue mantra of ‘personal responsibility’ with a hugging ‘we’re-all-in-this-together’ culture.”
Sounds about right to me. A little bit from both sides. Exactly what we no longer seem to get from the warring political parties back in Washington, D.C.
Danny Westneat’s column appears Wednesday and Sunday. Reach him at 206-464-2086 or firstname.lastname@example.org.