The public option should not be the only hot issue in the healthcare debate.
Before Congress acts, it needs to widen the personal options in any federal support of "wellness" programs.
Preventive care, such as company plans that help employees become healthy or stay healthy, may not be as simple an idea as lawmakers hope. Yes, an ounce of prevention is worth a pound of cure – as well as billions in savings – assuming more people adopt a better quality of life.
But a bill that aims to inject a government hand into personal health decisions should not slide easily into law without a larger discussion over who decides the various ways to wellness.
One Senate proposal, for example, would spend up to $10 billion a year to promote healthy lifestyles – building bike paths, for example, or encouraging farmers' markets – based on the idea that often a change in one's personal behavior is the best way to avoid illness.
It would also spend $1 billion over five years in support of wellness programs at companies with fewer than 100 workers. Already, many big companies save money on insurance costs by rewarding workers with hefty discounts on their premiums if they lose weight, kick smoking, or meet certain medical criteria. The bill would also try to prevent an employer or insurance company from imposing conditions that are "overly burdensome" or might reduce coverage of workers who don't fit a company's profile of wellness.
Preventing discrimination based on a person's health, however, is only one issue.
Another one involves workers who prefer privacy and don't want to reveal health information. Should they be forced to pay more for insurance? And could a company that mandates health tests for insurance purposes be in violation of the Americans with Disabilities Act?
But a more important discrimination issue may be this: How much should government-backed wellness programs define the methods of achieving and keeping health?
During the presidential campaign, Barack Obama was asked if he would support alternative methods of healing. He replied that government "should do what works." And in a speech to the American Medical Association, he asked Americans to take "more responsibility for our health and the health of our children."
Indeed, the practice of what is called "behavioral medicine" has become a big field, with more than 2,800 researchers and clinicians. Since 1999, some 43 academic medical centers, including those at Harvard and Duke universities, have banded together to study how to integrate emotional and mental aspects of healing into traditional medical practice.
And the Society of Behavioral Medicine, started in 1978, is studying health-related matters such as "self-control deficit" and "negative emotions" as possible indicators of illness. The society also asks that health professionals better understand connections between health and spiritual concerns. It cites empirical studies that show significant association of "selected spiritual and religious factors with important health and disease outcomes."
The federal government, too, is also exploring "what works" in alternative healing methods. The National Institutes of Health (NIH) finds that a doctor's "support of spiritual well-being in very ill patients helps improve their quality of life" and that spiritual well-being may also help a patient live longer. A 2004 survey of 31,000 Americans conducted for the National Center for Health Statistics found that the most commonly used alternative to medicine is prayer. NIH also advises physicians to consider referring patients to other methods "shown to increase spiritual well-being."
Such research indicates that Congress should be careful in excluding nontraditional, nonmaterial methods of healing and in limiting employers and insurance companies to narrow paths to healing and wellness.
If both private and government researchers recognize that a person's health depends to a large degree on behavioral or spiritual well-being, then Congress should likewise be wary of discriminating against individual choices in those directions.
Just like doctors, healthcare laws should first do no harm.