Get Fit

Demolition Man continues to be the only plausible dystopian vision for our time:

Likewise, U.A.W. members, assured of health care benefits that were the envy of the labor movement, had little incentive to take better care of their health, since their generous coverage would pay for most any ailment.

By contrast, Toyota, which pays premiums only for workers, not their families, has fitness centers at its factories and requires newly hired workers to exercise two hours a day during their training period.

The idea that people with generous health insurance have "little incentive to take better care of their health" seems ridiculous. One problem with getting cancer is that even people with excellent health insurance coverage often die. And even people who survive tend to find it an unpleasant experience. Similarly, I'd really, really, really prefer not to have a heart attack for tons of reasons unrelated to the financial cost of obtaining treatment for it.

Which isn't to say that the non-menacing element of what Toyota's doing here -- making exercise facilities more widely available -- couldn't do a lot to improve people's health. Most all of us don't really exercise as much as we should, and I at least am really good at coming up with excuses as to why today's a good day to skip the gym. Anything that's done to make it more convenient to get in a healthy amount of vigorous activity is good. And, indeed, finding policies to encourage healthy lifestyles is probably more effective than finding policies to deliver more medical care. Nevertheless, it's very hard to imagine that requiring "newly hired workers to exercise two hours a day during their training period" is going to accomplish very much except make your company look bizarre.

Comments

Matt is obviously not down with the thrill-seeking blue collar culture, which is always looking for the hippest elective surgery and most "rad" recreational disease. The cancer dudes scorn the lame diabetic poseurs, let me tell you that.

Posted by John Emerson | September 27, 2007 9:56 AM

So...Toyota doesn't pay for family health insurance. Then, who does?

Posted by jonm | September 27, 2007 10:00 AM

what was to prevent GM, Ford or whoever else was footing the bill for the "excessively generous" UAW health plan from opening gyms if that really did lower the cost of health care? i cannot believe someone would write such a ridiculous statement as an objective, "journalistic fact"; it appears to be sloppy application of principles poorly learned in econ 101.
as for the agreement, does it not appear that the UAW assumed 80 years of health risk for two years of job guarantees? this strikes me as about as wise as when the UAW was striking deals for job guarantees for healthcare back in the 80's and 90's.
as toyota's gyms: is it not common in japan for large industries to have such facilities?

Posted by larrybob | September 27, 2007 10:05 AM

Auto assembly can be a physically demanding job, and I would guess many new hires are not in shape to handle a full shift with high productivity.

Posted by Th | September 27, 2007 10:10 AM

One problem with getting cancer is that even people with excellent health insurance coverage often die. And even people who survive tend to find it an unpleasant experience. Similarly, I'd really, really, really prefer not to have a heart attack for tons of reasons unrelated to the financial cost of obtaining treatment for it.

The wording of the original sentence was poor, but don't ignore the importance of aligned incentives at the margin.

what was to prevent GM, Ford or whoever else was footing the bill for the "excessively generous" UAW health plan from opening gyms if that really did lower the cost of health care?

Nothing was stopping them, but since they were paying insurance premiums, rather than direct health costs, they would not see any of the cost savings; only the insurance companies were. It's very hard to quantify those savings so it's unlikely the insurance companies would give them back.

Posted by right | September 27, 2007 10:11 AM

One problem with getting cancer is that even people with excellent health insurance coverage often die. And even people who survive tend to find it an unpleasant experience. Similarly, I'd really, really, really prefer not to have a heart attack for tons of reasons unrelated to the financial cost of obtaining treatment for it.

The wording of the original sentence was poor, but don't ignore the importance of aligned incentives at the margin.

what was to prevent GM, Ford or whoever else was footing the bill for the "excessively generous" UAW health plan from opening gyms if that really did lower the cost of health care?

Nothing was stopping them, but since they were paying insurance premiums, rather than direct health costs, they would not see any of the cost savings; only the insurance companies were. It's very hard to quantify those savings so it's unlikely the insurance companies would give them back.

Posted by right | September 27, 2007 10:11 AM

"Nevertheless, it's very hard to imagine that requiring "newly hired workers to exercise two hours a day during their training period" is going to accomplish very much except make your company look bizarre."

How long is the training period? If it's three weeks long, then this requirement might help make exercise a habit for folks for whom it hadn't been previously. Sometimes people discover, to their genuine surprise, that they like exercising, and they never would have known had it not been required.

Posted by Kurzleg | September 27, 2007 10:20 AM

By contrast, Toyota, which pays premiums only for workers, not their families, has fitness centers at its factories and requires newly hired workers to exercise two hours a day during their training period

huh? toyota gets around the problem of not offering coverage for family members of employees by letting employees (but presumably not their family members) use a fitness center in the factory?

and if toyota pays for employees health coverage why wouldn't they have the same alleged disincentive to take care of themselves as the UAW members?

i can't be the only one who thinks the pro-toyota argument makes no sense at all, even aside from the point that MY makes in this post.

Posted by upyernoz | September 27, 2007 10:21 AM

it's very hard to imagine that requiring "newly hired workers to exercise two hours a day during their training period" is going to accomplish very much except make your company look bizarre.

One reason people don't exercise is because they're afraid if they go running instead of staying in their cubicle until 7 pm, they won't be seen to be working as hard as that pasty nerd in the next cubicle who's always there late, eating dinner at his desk. Forcing employees to exercise removes the perverse incentive and makes life generally less sucky for everyone.

Plus, it's way easier to put together a softball team when everyone has to play.

Posted by brooksfoe | September 27, 2007 10:34 AM

By contrast, Toyota, which pays premiums only for workers, not their families, has fitness centers at its factories and requires newly hired workers to exercise

I'm not sure how not paying premiums for family members is supposed to be an incentive for the workers to exercise. Anyone care to explain this? Looks to me like the Times got bamboozled.

Posted by Steve Balboni | September 27, 2007 10:37 AM

Can somebody explain the Demolition Man joke, please? I don't get it. And yes, I did see the movie.

Posted by Antid Oto | September 27, 2007 10:39 AM

Want to make employees exercise? Put the closest parking space a half-mile from the entrance of the building.

(If you really want them to live more healthy lives, put the plants in urban areas where they can walk from home.)

Posted by Sean | September 27, 2007 11:12 AM

You can go to a dozen countries in which everyone gets "generous coverage that would pay for most any ailment" and see whether these populations are in worse health. The answer is pretty obviously no. Also, while exercise is good for cardiovascular health, there's quite a bit of evidence that it's not the magic bullet that's going to turn around the US obesity epidemic, despite what your doctor tells you.

Posted by me2i81 | September 27, 2007 11:32 AM

"Incentive" is a hard medical term to put into practice as personal health care doesn't follow rational decision making. For example, eating fast food crap (which, I admit, I love), increases the chance of heart attacks - but years down the line. Today, I see no harm in it. Same for smoking which increases cancer risk...but now right now (and moreover, we all know many smokers who don't get lung cancer!).

Posted by Adi Nadimpalli | September 27, 2007 11:43 AM

Yeah, I didn't get the "Demolition Man" joke either. When I think dystopian + Detroit, I think Robocop!

On the more substantive side of things, this isn't the first time I've seen the argument about "abusing" easily accessible health care. Granted, if care is cheap people will take advantage of it more often... But as MY alludes, when it comes to serious illnesses, this makes no sense.

Mayhaps a solution would be a plan with a better focus on "catastropic" coverage? Higher copays for checkups, and more comprehensive coverage for Cancer treatment and the like?

Posted by Just Another Greg | September 27, 2007 12:04 PM

Just Another Greg, that is a horrible idea. It would essentially give people a reason to miss out on checkups, checkups which can catch things like cancer and heart problems before they become catastrophic (and, then, enormously expensive).

I find this whole "if health care is too cheap people will abuse it" line of argument absolutely ridiculous. Nobody LIKES going to the doctor. Nobody LIKES getting sick. When you are sick you go to the doctor. If the doctor happens to prescribe a very expensive form of treatment, and you do it, you're not "abusing your insurance", you're doing what the doctor told you to do. And that's the POINT. He or she is the doctor. The expert.

People might abuse the system by, I don't know, going to the doctor when they got a small cold, or whatever, but that's not the cause of high health care costs today and everyone knows it.

Posted by Joshua | September 27, 2007 12:20 PM

exercise 2 hours a day? Nobody does that except fitness freaks. I workout 3 days a week 45min to an hour at most. I have great insurance and do not like going to the doctors but glad they were there for my angioplasty.

Posted by judson | September 27, 2007 12:27 PM

A big part of the reason people don't get enough exercise is . . . our car-oriented culture. But I'm sure Toyota's employees will be just fine, what with the gyms (and maybe the workers' families can have access to the gyms?).

Posted by mary | September 27, 2007 12:43 PM

They have a different work ethic

I suspect that in Japan you probably have to hold a gun to people's heads to get them to spend a little time taking care of themselves, rather then spending 12-hour workdays fixated on helping the corporation.

Posted by Glen Tomkins | September 27, 2007 1:11 PM

You're right: people shouldn't need to be forced to exercise, eat healthy, engage in preventitive medicine, etc.

The problem is that health is so all-encompassing that the only real aternative to forcing the issue is a 1960s-style sea change in the culture itself. A few little things here and there won't be enough - either make it impossible for someone to sabotage their own physical health (a la Demolition Man), or wait or brainwash people into not wanting to.

Posted by Visceral | September 27, 2007 1:27 PM

I for one advocate re-education camps for opponents of single payer during the course of which they will get - among other things - plenty of exercise.

Posted by McGruff | September 27, 2007 1:36 PM

The really daft part of the coverage of this issue: not one outlet has pointed out that the Japan mandates the structure of their employer-based health coverage system. It is not part of a collective bargaining system. When the workers retire, they are covered by a citizens insurance that, in part is funded by general taxes. Besides this, healthcare generally justs COSTS LESS in Jpn

In short, Toyota can compete because all Japanese citizens are covered, costs are lower and they are predictable. This latter factor is vitally important but often under-appreciated.

Posted by Ryan | September 27, 2007 1:53 PM

There's a simple, glaringly obvious problem with this particular often-repeated right-wing talking point: It's the WEALTHY folks with GOOD HEALTH INSURANCE that are most likely to go to the gym, watch what they eat, limit their alcohol consumption, avoid street drugs and quit or never start smoking. POOR PEOPLE with LITTLE or NO HEALTH INSURANCE are much more likely to engage in unhealthy habits. There's a lot of reasons for this pattern, but it shows clearly that having good insurance is correlated with BETTER, NOT WORSE, health care practices. (The caps are because I am so, so tired of hearing this appalling and grossly inaccurate argument over and over again.)

Posted by beckya57 | September 27, 2007 2:02 PM

"Likewise, U.A.W. members, assured of health care benefits that were the envy of the labor movement, had little incentive to take better care of their health, since their generous coverage would pay for most any ailment."

For this to qualify as reporting, the article needs to quantify the number of UAW members whose attitudes towards their overall health were determined by the quality of their insurance program and not the culture in which they live. I seriously doubt that a single one of them thought (even unconciously) "I don't care if I get shingles, I have great insurance!" or "Heart-attack, shmart attack, I've got great insurance!"

This isn't reportage, it is right-wing editorializing.

Posted by left coast | September 27, 2007 2:35 PM

As far as I am concerned, the biggest issue here is that Toyota does not provide health-insurance for familites. Under the Republican ideal of health-care, we obtain health-care insurance for ourselves and dependents through private insurance obtained through employment.

So if a large, profitable, manufacturing enterprise cannot or will not provide health-insurance for families, who else will?

Can someone against National Health care tell me how our current system can operate and function if the employers are consistently dropping coverage? Realistically, individual insurance is extremely costly, and, because there is not the pooling of risk, there is the increased chance you will be denied coverage due to genetic traits or other phisiological traits specific to that family or individual (i.e. - no coverage for obese or extremely expensive coverage for overweight folks).

It seems to me, the Republicans are kicking the can down the road when it comes to health-insurance.

Posted by Brad | September 27, 2007 2:41 PM

Demolition Man is the wrong cultural reference here. Try Michael Keaton's Gung Ho.

Posted by Dilan Esper | September 27, 2007 3:04 PM

Re: Also, while exercise is good for cardiovascular health, there's quite a bit of evidence that it's not the magic bullet that's going to turn around the US obesity epidemic, despite what your doctor tells you.

If it isn't, then what the heck is? I didn't start packing on more pounds until I ended up in a sedentary desk job 9 hours a day or more. When I was college I rode my bike everywhere and walked a lot too (and ate and most definitely drank more than I do now). Even three years ago when we had one car for two of us and I did a lot of biking for transportation I definitely shed some weight. Except in cases where there are physical problems, I can't imagine why exercize wouldn't take pounds off.

Posted by JonF | September 27, 2007 5:11 PM

Brad:

Usually when employers don't pay for coverage, dependent coverage at group rate buy have employees pay for their dependents' coverage.

Personally, I think that's a good development. Right know if both spouses have job that provide coverage, they are effectively compensated less than some of their co-workers.

And it also make employers become more open to hire people with family. While it may be illegal, I had seen it happen frequently. If two persons can both do the job, and one with dependents/another without, why should employers pay more total compensation for the one with dependents?

Posted by Kanchou | September 27, 2007 6:07 PM

My hunch is that the requirement for new hires--and only new hires--to exercise two hours a day is that only people in relatively good physical health to begin with can do this, so you end up with lower healthcare costs. It's similar to the cherry-picking effect of, e.g., putting your insurance office on the second floor so people who can't climb a flight of stairs won't buy insurance from you. If the level of physical exertion required to exercise for two hours is not necessary for the actual job, though, you might be in violation of the ADA.

Posted by jimn | September 27, 2007 6:14 PM

I'm no expert, but I think the _Demolition Man_ reference is to the _watchers_ (for lack of a better term) that fine Stallone every time he swears and does other bad things, and a culture that thinks sex is dirty and wrong. In general, the sort of top-down morality of DM LA.

Posted by N M | September 28, 2007 12:06 AM