Matthew Woessner, an associate professor of political science and public policy at Penn State and an NAS member, today (July 30) issued an open letter to Penn State employees urging opposition to the university’s “Take Care of Your Health” initiative. The letter has been posted to an AAUP website and the Chronicle of Higher Education has published an article about his call for “civil resistance” to the new rules. Professor Woessner has asked NAS to post his letter as well and we do so as a courtesy to him and our members. NAS has not taken an official position on the Penn State initiative or on Professor Woessner’s specific recommendations.
An Open Letter to Penn State Employees Concerning the University’s New “Take Care of Your Health” Initiative
Dear Penn State colleagues,
Skyrocketing healthcare obligations are a serious problem that confronts employers across the nation. Although no organization is immune from the rising costs of healthcare, how organizations deal with medical inflation reveals something about their values. While there are no perfect solutions to ever-growing healthcare expenses, universities, like Penn State must resist the temptation to needlessly compromise its employees’ privacy and personal freedoms in a misguided effort to control costs.
Recently, Penn State University announced that, as part of its “Take Care of Your Health” initiative, employees would be required to “complete an online wellness profile” as well as undergo a “preventive physical exam” designed to “help employees and their spouse or same-sex domestic partner learn about possible health risks and take proactive steps to enhance their well-being.” Employees who fail to comply with this university-wide mandate will be subject to a $100 per month surcharge deducted from their paycheck, until they agree to comply or find other insurance coverage.
While university administrators may be implementing this program with the best of intentions, coercing Penn State employees to undergo medical testing and requiring that they disclose personal medical information to a third-party online database is ethically indefensible. University employees should respond accordingly.
It is, frankly, unrealistic to ask Penn State’s 17,000 benefit eligible employees to collectively refuse to participate in the program. First, the university’s $1,200 yearly annual penalty would represent a genuine hardship for virtually all university employees. Accordingly, it is unlikely that a call for a widespread boycott would generate meaningful support. Second, even if all Penn State employees refused to take part in such a program, the resulting fines would create an annual two million dollar windfall for the organization’s budget, thus rewarding the administration for inserting itself in our private medical affairs.
To resist administrators efforts to implement this heavy-handed healthcare initiative, I propose university employees engage in acts of civil disobedience, designed to protect our rights, without subjecting individuals to the university’s draconian sanctions. To blunt the administration’s “Take Care of Your Health” initiative without enduring any needless hardship, I propose that university employees comply with the letter of Penn State’s demands in ways that undermine its potentially harmful consequences.
Step 1: Make arrangements to conduct Penn State’s “preventive physical exam” with your personal physician rather than through Highmark Blue Shield’s mobile medical teams.
Penn State’s human resource representatives have assured me that university employees will retain the right to have the “preventative physical exams” performed by their personal physicians rather than with Highmark Blue Shield’s mobile medical staff, provided their doctors fill out a form listing the results of the mandated tests. According to the July 11th press release, these tests include “a full lipid profile, random glucose, body mass index, waist circumference and blood pressure check.”
While I’m distressed that the university feels that it can require medical testing, there are several reasons why Penn State employees should take advantage of the opportunity to satisfy the mandate by scheduling a visit with their personal physician. First, scheduling a consultation with their doctor will ensure that this information is taken in a safe and comfortable environment, rather than in a mass clinic run by the university’s insurer. Second, as an agent employed by the university to contain healthcare costs, Highmark Blue Shield is not, by definition, always looking out for the employee’s best interests. By contrast, an employee’s doctor is entirely concerned with their health. By discussing their medical concerns with their physician, employees can be assured that the advice is tailored exclusively to their needs, and is not commingled with interests of the insurer. Third, if ten thousand Penn State employees set up previously unscheduled doctor visits, (particularly if they are scheduled as full check-ups) it will have the effect of frustrating the university’s narrow budgetary objectives, making the cost of implementing these “basic biometric screening” simply unsustainable.
For those who want to take this a step further, Penn State employees might want to consider asking their doctor for a note attesting to the fact that they have undergone all of the required screenings, but will not report the results on the certification form. Technically Highmark Blue Shield has access to these medical records. They can retrieve these results on a need-to-know basis. Therefore, if the university is really just interested in starting conversations about “possible health risks” and encouraging employees to “take proactive steps to enhance [employee] well-being” certifying that we’ve conducted the test and met with a doctor, should be more than sufficient.
Although I remain concerned by the precedent of mandatory health screenings, it would be wise for the employees to comply with the health screenings in a manner that minimizes Penn State’s involvement in the process.
Step 2: Complete your online “wellness profile” by feeding the database ludicrous information.
As an academic, I value truth as among the highest personal and professional virtues. Our profession is built on an honest appraisal of facts, and on the dissemination of truthful information. However, I’m also a firm believer in liberty and privacy. In coercing university employees to put their medical information online, Penn State has crossed so many ethical lines, I believe that the only reasonable response is to dutifully create the “wellness profiles” and fill them with junk. I, for one, plan to stack my profile with ludicrous information that neither discloses my personal medical history, nor provides the website sponsor (WebMD) with useful information that can be used to study Penn State employees.
To fully appreciate the serious ethical breech that is being perpetrated by Penn State University, in requiring that we fill out these “wellness profiles,” consider how these tactics would be viewed if employed by any university professor when conducting an academic study. In a university setting, the use of human subjects, whether for medical experiments or survey research, is governed by an institutional review board (IRB) whose primary objective is to ensure that studies conform to high ethical standards. First and foremost, university IRBs require that studies involving human participants are conducted with their full consent, free from coercion (whether physical, financial or psychological) of any kind. Furthermore, even if participants do volunteer to participate in a survey, they retain the right to opt out of questions which they find embarrassing, threatening, or simply too personal.
A cursory look at the survey component of Penn State’s “Take Care of Your Health” initiative reveals that the university’s actions don’t meet either of these basic criteria. First, by definition, the University is securing participation in the wellness profile through coercion, docking employees $1,200 for every year that they refuse to take part in the online survey. Second, in order to complete the wellness profile, applicants are required to answer each and every question built into the survey. When asked if their doctor has diagnosed the respondent with colon polyps, ovarian cancer, prostate cancer or depression, the website options are simply “yes” or “no.” Similarly, male respondents are required to disclose if they perform a “monthly testicular self-exam.” Female respondents are required to report if they conduct regular “breast exams.” As it is designed, the online wellness profile prohibits participants from opting-out of questions that the respondent deems embarrassing, too personal or simply inappropriate. A failure to answer any of the survey questions generates a red flag beside the omission and participants are prohibited from advancing to the next page of the WebMD profile. Therefore, refusing to answer any one of the questions, makes it impossible to complete the profile, and under Penn State’s rules, subjects them to the full financial penalty for opting out of the mandatory “Take Care of Your Health” initiative.
It’s worth noting that, it’s entirely possible that these sort of intrusive questions and coercive tactics are permitted under the Patient Protection and Affordable Care Act. Whatever one thinks of Obamacare, the healthcare reform has had a number of unintended consequences. Even so, an act of Congress does not suspend the university’s moral obligation to secure participation in a fair and ethical manner. Whatever the legalities of this survey, if the online “wellness profile” could not withstand a basic IRB review, I do not believe that Penn State employees are under any moral obligation to feed this database with useful information.
As to the logistics of subverting this online system, I, for one, will fill the profile with absurd information, to emphasize that it is not my intent to deceive Highmark Blue Shield, but merely to comply with my employer’s unethical mandate. For example, by my profile, I’m 3 feet 8 inches tall, I weigh 50 pounds (the minimum values permitted by the website), and my last cholesterol test was performed when I was six months old. Others might be concerned that pumping the database with ridiculous information might raise red flags down the road. Some conscientious objectors might take a different tactic, opting to fill out their profiles as if they were in peak physical condition (6 feet 2 inches tall, weighing 180 pounds). Like me, I presume that most dissenters will opt out of disclosing any actual medical ailments.
When I raised the possibility that faculty might protest by filling these WebMD profiles with nonsense, Penn State’s HR representatives confirmed that the university has no way of verifying the veracity of the information placed in individual files. The university is operating under the assumption that employees are going to voluntarily turn over their personal information, even though we’re being coerced to participate in the program. By their estimation, we’re too docile to do anything but fully cooperate with the university’s demands. I believe the university administrators are in for a real surprise. Given the employee’s resentment at being forced to take part in this wellness profile, without any meaningful enforcement mechanism, I suspect participants will complete the survey. Nonetheless, I doubt much of the information will bear any relationship to their actual health practices or physical condition.
In calling on Penn State employees to engage in a passive resistance to the university’s “Take Care of Your Health” initiative, I’m not suggesting that the university surrender to skyrocketing healthcare costs, or sit on the sidelines when it comes to promoting healthy lifestyles. If the university wants to promote good eating, health clinics, and smoking cessation programs, they have my full support. If the university wants to encourage employees to take advantage of WebMD’s wellness profile, I don’t see the harm. As long as Penn State confines itself to gentle advocacy rather than outright coercion, it will enjoy the broad support of its employees, as well as the public at large.
While I am a proponent of diet and exercise, and I recognize the financial advantages of healthy living, Penn State University must respect the personal choices of its employees. If its efforts to encourage healthy living aren’t enough to change people’s lifestyles, then I, for one, am willing to bear that additional cost. In the end, privacy and personal freedom are more important than securing modest healthcare savings many years down the road.
Whatever its merits, the use of financial penalties to compel compliance with its paternalistic “Take Care of Your Health” initiative is simply a bridge too far.
Matthew Woessner, Ph.D.
Associate Professor of Political Science and Public Policy
University Senator, Penn State Harrisburg