Thursday, August 1, 2013

Penn State's New "Wellness Program" in the News (UPDATED Through 8 August 2013)

I wrote some weeks ago about the movement by private sector and business related enterprises, including universities, toward a new eugenics directed to the management of the health and social habits of their employees, one driven by cost containment policies (e.g., The New Eugenics--The Private Sector, the University, and Corporate Health and Wellness Initiatives, July 16, 2013)

 (Pix (c) Larry Catá Backer 2013)

Since then Penn State University has been very much in the news about a wellness program it announced several weeks ago, one which has generated interest in part because of a curious component penalizing employees who fail to embrace the eugenics program built into the new "wellness" system. This post provides an update.  It is provided in the interest of analysis and debate, including on the general issues raised by programs of this kind of benefits offered by enterprises in the U.S. It also suggests some of the complications of emerging issues of consultation in shared governance contexts in the face of increasingly large informational asymmetries between administration and faculty. 

Penn State has recently announced the launch of the “Take Care of Your Health” initiative which requires all PSU employees (and, in some cases, spouses/domestic partners covered under employees’ medical plans) to (1) complete a Wellness Profile on a third party website – WebMD, (2) certify that they will have scheduled a preventative physical exam during 2012/13 and, (3) complete a biometric screening exam by November 22, 2013. Failure by either employees or their health-care dependent spouse/domestic partners to compete these steps will result in the imposition of a $ 1200 salary surcharge ($ 100/month deducted from non-complying employees paychecks for 12 months on a pre-tax basis). Not surprisingly, this initiative has set off a wave of commentary questioning the program’s efficacy, impact on medical privacy, and general legality. And, at least one Penn State faculty member is now calling for Penn State employees to engage in “civil resistance” to the entire plan.

I have included the following links to the public discussion of the Penn State wellness program in hopes of aiding thoughtful discussion of the larger issues raised, many of which have implications for policy far beyond Penn State:

1. FAQ prepared by Penn State’s Human Resources Department addressing questions about the “Take Care of Your Health” Initiative.

2. The article that appeared to be the first to report on the new "wellness" program: Colleen Flaherty, Weigh in Or Pay, Inside Higher Ed, July 22, 2013. Available

3.  July 25 article appearing in the “Penn State News” website explaining Penn State’s reasoning behind the Initiative.

4. Karen Heller, Penn State's Unpalatable Policy on Health, Philadelphia Inquirer, July 25, 2013.

5. Robin Wilson, “Professor Urges ‘Civil Resistance’ to New Penn State Health-Care Rules," Chronicle of Higher Education, July 30, 2013 (including analysis by faculty of the consequences and character of this plan).

6. Open letter to Penn State Employees written by Matthew C. Woessner, an associate professor of political science and public policy at Penn State's Harrisburg campus referenced in the Chronicle article calling for “Civil Resistance” to the Initiative: A Call for Action and Civil Resistance for Penn State Employees, Posted on An Open Letter to Penn State Employees Concerning the University’s New “Take Care of Your Health” Initiative.

7.  George Leef,  Penn State Goes Big Brother on Health Issues, National Review, July 29, 2013.

8.  Jeff Brady, Penn State To Penalize Workers Who Refuse Health Screenings, NPR, Aug. 2, 2013 (focusing on the penalty features of the wellness program and calls for employee resistance).

9. Kevin Volpp and Mark Pauly Critique Penn State's Wellness Program, University of Pennsylvania Leonard Davis Institute of Health Economics, July 29, 2013.
In interviews on NPR radio station WPSU and in the Philadelphia Inquirer, LDI Senior Fellows Kevin Volpp and Mark Pauly critique a new Penn State wellness plan that requires non-participating employees to pay a $100 monthly surcharge for their health insurance.

Volpp, MD, PhD and Director of the University of Pennsylvania's LDI Center for Health Incentives and Behavioral Economics (CHIBE) noted that, "a penalty-type program doesn't engender warm feelings among the employees that the employer is looking out for their best interests and is just trying to help them." CHIBE is a research center heavily involved in studying incentive and penalty systems designed to encourage healthier employee lifestyles and behaviors. He pointed out that penalties, instead of modest rewards, can "have negative consequences."

Also commenting on the controversial program in the same Inquirer story, Wharton Health Care Management Professor Mark Pauly said "It's a pipe dream that it will save Penn State money."

Pauly, PhD, explained that employers across the country are increasingly requesting employees' health information, but said the Penn State program "is far more aggressive in terms of its punishment."

I hope that you find my packaging of these linked articles to be useful in your own understanding and analysis of this new Penn State initiative.  I note that with respect to the sufficiency of consultation with the University Faculty Senate there may be a disagreement about its sufficiency.  I have suggested that though I am happy to hear that the university and its public relations office  provided details of what it understood to be its efforts to reach out to members of the faculty senate, determinations of the scope of adequate consultation is a highly contextual matter the appropriateness of which reasonably depends on the importance of the subject to be considered.  But faculty generally have no way of gauging importance in the absence of administrative disclosure. Faculties depend on information from administrators about the scope and intent of policy initiatives; in the best case, which does not occur frequently enough, faculty are also involved in the policy choices that produce movement toward program construction.  Consulting members of the senate, and consulting committees that might form part of the Senate hierarchy, while laudable, and an important means of working together informally, does not amount to the sort of consultation that is reflected, for example, in the Senates advisory and consultative procedures. And indeed, the Senate, as a body, never undertook to exercise its advisory and consultative role. Consultation, to my mind, is subject to a reasonably applied rule of proportionality; the more important the subject the more extensive and formal the requirements of consultation.  More importantly, only administration officials were in a position to know what they were planning and to decide how its plans were to be presented.  Those with knowledge might reasonably bear the burden of ensuring appropriate communication to permit shared governance partners to make an assessment of appropriate levels of consultation in light of all necessary facts. As a consequence, on this point, it is likely that there may be a difference of view about the meaning of appropriate Senate consultation, especially with respect to university initiatives of the importance of this one.

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