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County's wellness program for insured workers a good step on a difficult path

Mar 7, 2014 - By Chris Peck

Would you pay more to be fat?

Conversely, would you like to pay less out of pocket for your health insurance if you are living a healthy lifestyle?

Fremont County commissioners are looking into questions like these -- and it's a worthy cause.

Because Fremont County -- and all of Wyoming -- isn't in the best physical shape.

A 2013 Wyoming Department of Health study of the state's lifestyle found that only 13 percent of state residents are living what docs would call a health lifestyle.

"Healthy lifestyle" is defined as not smoking, getting regular exercise, and eating your vegetables. And we're not doing it.

In Fremont County, seven of 10 people admitted to not eating enough veggies according to the study.

Half the county's residents fessed up to not exercising in any regular way.

Stats like these that explain why the county's health care bill is rocketing upward.

In a recent Ranger story, the commissioners noted that they are grappling with a year-over-year 15 percent rise in the cost of providing county government workers with health insurance.

The now $6 million annual price tag for county health care coverage puts pressure on all other kinds of county services, from road repairs to law enforcement.

That the commissioners are trying to get a handle on health care costs is a noble exercise in good government.

The basic idea, as outlined by commission chairman Doug Thompson, is to provide a financial incentive to be healthier.

Keep your body weight in check, make sure your blood sugar levels and cholesterol levels are good through the right diet, and post low blood pressure numbers through exercise -- and county workers will pay less for their share of county health insurance than they do now.

And if you don't do that, then your county health insurance co-pay could double.

This is a meaningful incentive plan. If it works, the county will see a drop in the number of medical procedures that are the result of poor health.

Money will be saved. County workers will be healthier.

A win/win.

But if it were that easy, the nation wouldn't be in a health care crisis.

Already, the U.S. spends 40 percent more on health care than other developed countries.

A recent Commonwealth Fund study found that the U.S. healthcare system compares unfavorably with the health care outcomes in many other developed nations. We spend more, yet we die sooner, suffer more from obesity and diabetes, and actually have a tougher time getting to a doctor.

Especially in Wyoming -- where nearly 25 percent of people don't have a doctor at all -- and live miles from a doctor's office.

And there is something more that will challenge the county's innovative incentive plan.

In a candid moment, many doctors will admit that half of their patients are coming to see them not for medical reasons but for family problems, depression, domestic abuse, or drug and alcohol issues.

Most recently, research into adverse childhood experiences -- things that happen to you as a kid -- now suggests that bad things that happened to you in your home as a child end up playing a huge role in later health challenges.

Adult obesity among women can be a defensive mechanism as a result of sexual abuse as a kid.

Drinking too much may be a response to physical abuse endured at home long ago.

And all of these interrelated, underlying causes of medical problems, unfortunately, can't be addressed just by having the right incentives in place for healthy lifestyles.

Yes -- the incentives are important, forward-looking, and should be adopted by Fremont County government.

They are a good start in what must be an even more comprehensive study of the complex universe of issues and behaviors that define who is healthy, what it costs to stay healthy, and how manage our lives.

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