Ed Housewright, the Collin County columnist for the Dallas Morning News published a jewel of a column on August 5th in the Dallas News about the "shape" of local city government employees in Plano, Richardson, Dallas, and especially in the Collin County government.
Mr. Housewright reported on the unbelievably generous group health benefits offered to employees of these cities, and the truly unbelievably poor health condition of the city and county workers.
Some of the highlights of his column: Collin county employees have a group health insurance plan with no deductible! And a worker for the city of Plano has a $500 deductible, Richardson a $350 deductible, and Dallas workers a deductible of $300.
What's even more astounding is that these local governments are picking up almost all of the cost for the group health insurance plan. A Collin county worker pays only $30 bucks a month for "double platinum" group health insurance coverage, a Dallas worker only $137.
This makes me so glad to know that I have a $5,200 family deductible consumer driven health plan with no copay benefits so I can afford to pay taxes to my city that offers a no deductible health plan for government workers.
Of course, no tax paying business in these communities could ever afford the premiums for this type of plan for its employees. But somehow local governments see nothing wrong about offering unheard of level of benefits to municipal employees, and are fatalistic and almost acceptant about the expense. Mr. Housewright reported that Collin county spent almost as much to run its entire judicial system as it did on medical claims last year.
The result of local government largesse? Government employee largeness, and runaway medical expenses, much of which is obesity related, and all paid for by the tax paying public.
United Healthcare, the second largest health insurance company in the country, cited Collin county as having 104% more cases of congestive heart failure than other governement bodies insured by the insurer.
Not only that, but Collin county had 81 percent more cases of coronary disease, and 127 percent more cases of digestive problems.
To make matters worse, up until 2006, Collin County picked up the entire tab for lap band or stomach staple surgery; now the employee has to try a year's worth of doctor-supervised dieting before getting the free $10,000 surgery. In 2005, the county spent about $600,000 in surgery cost (plus lost wages and productivity of at least that much.) The lap band and stomach staple surgery procedure just is not covered in 99% fully insured private sector group health insurance plans.
There is no doubt that obesity is a rampant epidemic among adults and children of Texas. The Texas Comptroller estimated that obesity cost Texas employers $3.3 billion in 2005, and no doubt that number is now about $4 billion per year. Now, it appears that this number was greatly underestimated, as obesity among Texas municipal workers is totally off the charts, and guess who picks up the tab? Yup, taxpaying businesses.
The only defense in Housewright's article for the poor health of the county's employees was from Judge Self, who heads the Collin County Commissioner's Court and took office in January. Self was quoted as saying "We have a bunch of sedentary jobs." EXCUSE ME??? What Texas business in non-agriculture and non-manufacturing does not have mostly sedentary jobs!
However, Collin county taxpayers should not worry; the new County Court building is hoping to open up a workout room, and the County now pays each employee $125 to go get an annual physical. Now that's progressive thinking from government officials with bold plans on how to stem a health epidemic among their own employees!
Several problems occur in many government and non-profit organizations that don't occur in profit businesses. First, there is no true measure of a government organization's profitability nor of employee productivity, and there is principle of "tenure," in which employees can often expect to have a job for life, regardless of how great a job they do, or how much they cost their employer.
Second, there is no market-driven force to balance what the organization can afford to spend for benefits on a cost per employee basis, so whatever it costs is okay with public officials. City and county employees get fatter each year, city and county budgets in Texas go up every year, homeowner's get higher assessments every year, and taxpayers get taxed more every year.
Imagine what type of response you get if you asked a Texas small business owner or a self-employed person if they felt that it was fair that their municipality's employees get $30 per month health insurance with no deductible, that they get free lap band surgery with sick pay, that they can accumulate weeks and months of vacation, and they get a better and lower cost retirement deal than social security which they don't have to pay for.
Let's not even consider the retirement benefits issue. Half of all small businesses in Texas can no longer afford to offer any group health insurance plan at all for their employees, and if they do, you can be sure that the employee is paying their fair share, and is grateful to have the benefit.
Perhaps the main difference between public and private sector that is causing this unprecedented employee health crisis is the organizational culture. In a for-profit business, the cost per employee, revenue per employee, and profitability per employee are key measures for every department and every employee.
And in a right to work, "at will" state like Texas, any employee working for a Texas business can pretty much be terminated at a moment's notice, even if they are doing their job. "Profitability correctness" is a known fact among the employee and management culture.
Public sector employees are much more likely to get terminated for "political correctness" errors than "profitability correctness." Thus an obese, "tenured" public employee who knows his or her "rights" knows that a manager is fairly powerless to do anything about it, since obesity is a "protected" condition under the American Disabilities Act.
A well-intended municipal manager can't use the "shape up or ship out" approach with an obese employee without incurring discipline, temination and/or a possible lawsuit.
Instead, public sector managers can only offerup weak initiatives like workout centers and free checkups that end up costing taxpayers more money. Frankly, I doubt many obese Collin county employees would want to go to the gym to work out, though they might want visit a doctor for a checkup if they get time off and a chance to pocket $125.
So we have a public sector employee health crisis and group health insurance conundrum that is costing taxpayers and businesses in North Texas communities like Dallas, Plano, Richardson, Allen, Frisco and Collin County and Dallas County hundreds of millions of dollars, and no public sector manager can really do anything about it.
Here's a suggestion that will cause change: First, a taxpayer-lead initiative that limits each government to spend no more in municipal employee benefits than the average of what comparable taxpaying companies located in the same municipality pay for employee benefits.
In North Texas, this would mean that for group health insurance, the government would pay no more than 60 to 75% of group health premiums that would cost about $400 per month for each employee. Of course, that wouldn't buy a very good plan since the municipality's employees are so obese the rates would be much higher.
I'd bet my tax dollars to their donuts that if municipal employees in Texas were held responsible to "real world" healthcare costs, there would be such peer pressure for employees to take care of themselves, that personal health accountability would soon become the new political correctness. Fewer donuts, fewer lap band surgeries, and lower health insurance and healthcare costs.
Once North Texas municipal employees are forced to "get it" that there is no more public sector health care gravy train, managers could then implement programs that are proven to lower the cost of healthcare if employees engage in them. Presently, there is no incentive for employees to change, and it is apparent that self initiative isn't working.
For example, HIPAA regulation changes that took effect in July of this year now allow employers to reward employees monetarily on a tax-free basis, up to 20% of the cost of group health insurance premiums for engaging in wellness programs that encourage employees to exercise, reduce weight, and stop smoking. So a municipal employer in Texas with a $400 per employee premium that an employee must pay 35%, or $140, but could be offered incentives of up to $80 per month if they enrolled in the wellness program, and lost some pounds, exercised, and stopped smoking.
As a taxpayer, I'd rather be shelling out tax dollars for a wellness plan knowing that municipal employees had some skin in the game, and that they are now accountable for improving their own health, rather than have my tax dollars go toward free lap band surgery with paid sick leave for grossly obese workers.
This approach would then be a tremendous carrot for managers to change behavior among municipal employees. Employees would now have a "real world" health plan with a "real world" high deductible and monthly premium payments.
And since each municipal employee's monthly premiums would then be tied to the overall health of the employee group, employees might even urge their self-indulgent fellow employees to improve their health because it costs them money, without the need for managers to intervene.
It might be a taxpayer's wishful thinking, but I could envision a day when the office cubicles of local municipalities have emproidered signs on the desks that read, "Thank You for Not Eating Donuts."