Wellness programs and the West Virginia Teacher’s strike

Earlier this week, John explained the wellness program that the West Virginia PEIA pushes called Go365:

Whoever came up with the idea for Go365 is a special kind of asshole…. I will give you a brief explainer. For decades now, as health insurance costs increase, corporations and organizations have been implementing wellness initiatives to try to encourage workers to engage in healthier lifestyles, which will lower health costs for the company, and in return there is usually a small reward- a small reduction in worker contribution, etc….

Go365 was like that, in the sense that it tried encourage employees to engage in healthier behaviors, but while normal wellness initiatives are all carrot, this was a gigantic stick up your ass and if you didn’t do it, they were going to charge you 500 bucks more a year. And it was invasive- biometric screenings, tracking your fitbit, etc. Apparently they tried to soften it a touch by letting you earn points for crap like free movie tickets….

There is very little quality evidence that shows broad employee wellness programs save money or increase health. Austin Frakt at the Incidental Economist had a good summary from late 2014 on this topic:

We’ve said it before, many times and in many ways: workplace wellness programs don’t save money.

Last week, on the Health Affairs blog, Al Lewis, Vik Khanna, and Shana Montrose said so too, adding some nuance we have not included in our posts on TIE. You should read the whole thing. Here are a few of my favorite passages:

It is beyond the scope of this posting to question non-peer-reviewed vendor savings claims that do not use any recognized study design.

I just love this phrasing of “we’re not reviewing crap.”

There is a recent NBER working paper that conducted a large randomized trial of wellness programs in Illinois:

we do not find significant causal effects of treatment on total medical expenditures, health behaviors, employee productivity, or self-reported health status in the first year. Our 95% confidence intervals rule out 78 percent of previous estimates on medical spending and absenteeism. Our selection results suggest these programs may act as a screening mechanism: even in the absence of any direct savings, differential recruitment or retention of lower-cost participants could result in net savings for employers.

It changed no behaviors. Instead it rewarded or punished previous behaviors. Now if you are an HR rep for a small self-insured, setting up a wellness program that is very attractive to low actuarial risk individuals and ugly to people with a high likelihood of needing expensive care, there is a certain amount of logic to run people away. That works until it does not and it begins to fail miserably when the insurer is also a monopsonistic buyer of a particular type of skills and services as they are going to get everyone in the pool anyways.

Broad wellness programs are intrusive, expensive and ineffective at actually achieving what they claim they want to achieve: improved health and lower costs. And yet we keep on doing them.


Give those crafty Europeans credit for knowing their symbols:

“We will put tariffs on Harley-Davidson, on bourbon and on blue jeans – Levis,” European Commission President Jean-Claude Juncker told German television.”

It is worth noting that not only are these the stereotypical (one might almost say, caricature) emblems of Americana, Harley’s are made in Wisconsin, just north of Paul Ryan’s district and, as we all know, McTurtle is from the great corn-mash state of Kentucky.

Funny how a policy conceived in ignorant petulance has obvious, immediate, and hugely stupid consequences.

You may consider this both a proof-of-life post and an open thread.

(Truly astonishing NSFW the-world-was-sure-different-then image below the fold)

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Late-Night Open Thread: The Lyin’ in Winter

And here Donald thought he’d found himself a “son” who was a competent grifter!

It’s been a truism since at least Jimmy Carter’s presidency that Washington DC is “wired for Republicans”, but it’s a company town and these Trump goniffs are damaging the brand. I suspect the stories Roxanne Roberts shares in the Washington Post hurt Jared, Ivanka, and their socially-insecure old man’s feelings much more than any Democratic accusations of treason / incompetence / general venality — “Washington society and Team Trump: A year in, the fear and loathing is mutual”:

The president and many of his closest advisers are contemptuous and suspicious of the Washington establishment, which they dismiss as the “swamp.” And the city’s social elite, normally quick to embrace a new chief executive and his inner circle, are judgmental, wary and afraid of being, as one Republican put it, “tainted for life.”

“This establishment is trying to reject Trump and his family like white blood cells chasing off an infection,” says conservative anti-tax advocate Grover Norquist, who has lived in Washington for 33 years. And Trump loyalists, he says, see little value in rubbing shoulders with people who didn’t want anything to do with them before the election…

The Trumps, for their part, seem to want not just respect and courtesy but personal allegiance. One Republican hostess, eager to introduce Trump family members to some of her friends, was told that they were interested only in people who are “loyal” — a term rarely used to describe social acquaintances…

There was a moment when Ivanka and Jared seemed like the perfect bridge between the White House and social Washington. They were young, glamorous and chic, the ultimate power couple in a city full of them. They had impeccable manners and were eager to engage. They hosted small dinners at their Kalorama home for members of Congress, administration officials and other prominent Washingtonians…

That mutual admiration was short-lived. The couple apparently became increasingly disenchanted with Washington after the Russia scandal broke, surprised by what they considered vicious, unfair attacks. Whatever goodwill they felt toward the establishment has reportedly evaporated, and the two are rarely seen at social events outside the president’s orbit.

Meanwhile, the A-list was surprised by what some describe as the self-importance and humorlessness of Team Trump. “This is the first administration,” one fundraiser says, “where you can’t tease.” …

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Open Thread: Notes from the “President”‘s “Listening Session”

Of course he likes it — he’s on the teevee, and other people have to do all the hard work!

Daniel Dale, of the Toronto Star, live-tweeted the whole performance. Click on any tweet for the whole spool:

(Note the recurrent Wingnut trope: I have a godgiven First Amendment right to be stupid! And if you attempt to point out how stupid my idea is, that’s censorship!)
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Browser Outrage Dump

Time for another thread, I’d say, and I don’t have the functioning synapses to come up with anything new to say about the moral and intellectual crater that is both the Republican Party and the right’s public intellection bunch. (Did you know that Ron Johnson’s mug is being considered as the “After” portrait in the upcoming “Don’t Eat Tide Pods” campaign? Or that Rod Dreher’s thought leading crunchy conservative Christianity is racist to its root?)

So here I’m just going to lock and load some stuff I’ve kept open in my browser, waiting for the moment to foam in rage over here.  Think of this not so much as considered analysis (don’t think of it as all). Rather, it’s a very partial catalogue of how much damage decades of GOP anti-government, and worse, anti-society sabotage has done.  A goad, perhaps, though I hope no new one is needed, to crush these sorry f**ks come November, and forever after.

So here they come, in no particular order:

From Stat: “Drop in U.S. life expectancy is an indictment of the American health care system”

According to the CDC, the average life expectancy at birth in the U.S. fell by 0.1 years, to 78.6, in 2016, following a similar drop in 2015. This is the first time in 50 years that life expectancy has fallen for two years running. In 25 other developed countries, life expectancy in 2015 averaged 81.8 years.

The article acknowledges the impact of the opioid epidemic on those figures but notes that cross-country comparisons reveal systemic failures that make the disaster so much deeper here.  And then there’s the way we treat — or don’t — our elderly:

It is widely accepted that the accessibility and quality of medical services strongly affect life expectancy among the elderly and elderly Americans fall behind their counterparts overseas when it comes to being able to get and afford the health care they need.

This may seem surprising given that Americans over 65 enjoy universal health insurance coverage under Medicare. But as valuable as Medicare is, it provides far less protection against the cost of illness, and far less access to services, than do most other Western countries. In a recent cross-national survey, U.S. seniors were more likely to report having three or more chronic illnesses than their counterparts in 10 other high-income countries. At the same time, they were four times more likely than seniors in countries such as Norway and England to skip care because of costs. Medicare, it turns out, is not very good insurance compared to what’s available in most of the western world.

Next: that GOP assault on environmental regulation and protection?

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Shithole President. Shithole Party.

So, this happened, as reported in The Washington Post:

Why are we having all these people from shithole countries come here?” Trump said, according to these people, referring to African countries and Haiti. He then suggested that the United States should instead bring more people from countries like Norway, whose prime minister he met Wednesday.

As Josh posted at TPM, highlighting a blunt and unequivocal report on this over at CNN, such a pure distillation of racism is too blatant to be ignored, even by the most circumspect MSM venues.

There is, in a sense, nothing new here: anyone paying attention has known that Trump is and has been for his entire adult life a gaping maw of racism, a bigot who doesn’t just loathe black and brown people, but has a record of seeking to do them harm.

It remains astonishing to hear anyone in 2018 say such filth in their outdoor voice, but no one can say they’re surprised that if anyone in American public life were to go loud and proud on the crudest expressions of race-hatred, it would be the –tragic– occupant of the Oval Office, that tiny-fingered and terrified little scrub, Donald Trump.

But if Trump is merely making it more obvious that he’s a one-man lynch mob in waiting, now with the levers of power at his vicious disposal, there’s another set of accessories, the men and those occasional women they allow into the clubhouse who lead the Republican Party.

They were the ones who accepted the devil’s bargain — trade American democracy to wield power through the presumed-to-be biddable Trump.  And now they face, and routinely fail, the test their notionally smart and stable leader poses for them:  stick with Trump, or defend this norm or that.

As everyone reading this knows, to date, it’s been Trump, and to hell with the notion of democratic governance, any of the expectations of the Founders and their heirs.  From judges to taxes to tolerating personal corruption in the White House, and on to the terrifying surrender of huge swathes of government to incompetent cronies, to the attempted capture of law enforcement as a tool of the president, and more, through the whole wretched catalogue, the GOP has chosen to see nothing, to hear nothing, to say nothing — and thus has associated themselves with each sin, all the blows to traditional forms, and every outright felony the Trump crime family commits.

And now this:  Trump, uttering out loud the hate soundtrack that loops constantly through his lizard brain.  This time, he was so obvious as to make it clear even to the meanest comprehension (not implying anything about CNN).  There’s no hidden meaning, no subtext in his words.  This ain’t eleven dimensional chess or brilliant electoral strategery.  January 11, 2018 ain’t the day that Donald Trump became President.

It’s the one on which he reminded us exactly what kind of president he is, what kind of leader the GOP accepts, welcomes, follows.

And thus the test: every single GOP member of Congress, every cabinet official, every White House staffer who fails to condemn this statement, owns it — along with all the sentiments and intentions behind it. They become the bigots, aiders and abettors of the worst impulses in the public sphere. They are to be named and shamed; small children should grimace to see them and each of us will spit on the sidewalks as they pass.

Or, more practically — every single one facing the voters in 2018 and as long as Trump is present on the American political scene has to be asked where they stand on shithole countries.  Ryan and McConnell and all the rest have to be made to choose: Trump and the worst tendencies in our country, or not.

/rant over.  Only this to add:  my stomach hasn’t unknotted since I read this.  Not to Godwin, or anything, but it’s a truly sad day when the President of the United States utters words that would have fit perfectly in Adolf Hitler’s mouth.

Image: Hieronymous Bosch, The Last Judgementbetw. c. 1482-1516

Open Thread: Local Races, Utah Edition — High & (Very, Very) Low


The professionals weigh in…

As a fellow Masshole, I concur with Mr. Pierce:


Wanna-be Breitbrat Jacob Wohl chips in with a cunning plan

TBH, since the Fusion GPS / Wolff book news dropped this morning, I suspect Steve Bannon’s got quite enough on his plate without an expensive referendum on how much consistent GOP voters don’t like him. But it’s good to know the hardcore racist/sexist/nativist bigots will be harrassing Romney from the right while the Democrats are pushing our “leftist” (humanist) agenda!