TRASHFUTURE - *PREVIEW* No Healthcare, Only Wellness feat. Tamara K. Nopper and Eve Zelickson

Episode Date: August 25, 2023

For this week’s bonus, we spoke with Tamara K. Nopper and Eve Zelickson from the Data and Society Research Institute. They’re the authors of “Wellness Capitalism: Employee Health, the Benefits Maze, and Worker Control.” Would it come as a surprise to you to learn that employee data and tech-driven ‘wellness solutions’ are increasingly offered as employee benefits in the US, in the sense that you can’t actually get psychotherapy on your insurance, but a chatbot can offer you cognitive behavioral therapy? Not a surprise at all? Well, we have just the conversation for you. Check out the primer here! https://datasociety.net/library/wellness-capitalism-employee-health-the-benefits-maze-and-worker-control/ Get the whole episode on Patreon here! https://www.patreon.com/posts/no-healthcare-k-88153359 *STREAM ALERT* Check out our Twitch stream, which airs 9-11 pm UK time every Monday and Thursday, at the following link: https://www.twitch.tv/trashfuturepodcast *WEB DESIGN ALERT* Tom Allen is a friend of the show (and the designer behind our website). If you need web design help, reach out to him here:  https://www.tomallen.media/ *MILO ALERT* Check out Milo’s upcoming live shows here: https://www.miloedwards.co.uk/live-shows Trashfuture are: Riley (@raaleh), Milo (@Milo_Edwards), Hussein (@HKesvani), Nate (@inthesedeserts), and Alice (@AliceAvizandum)

But what we talk about, though, about the transition from the new deal and away from that getting in mourning to the employee sponsored, employer, excuse me, sponsored wellness or assistance programs, you say that it sort of supercharges under the under-Obama care, which is this moment of enormous expansion for companies and schemes that are ubiquitous because they are not just tacitly encouraged by the government as they would have been in the 70s under Nixon, but that they are now sort of there's a huge bananza for companies offering these these kinds of services. So with the affordable care act, which was passed in 2010 it actually like directly incentivized employers to adopt these health and wellness benefits. There was this part called the Safeway Amendment, which refers to this supermarket

chain in the US. And their CEO at the time was kind of boasting in the media and to all of these politicians about how over I think it was a period of four years, he had managed, or safe way, had managed to keep there a healthcare cost stagnant because of their employee wellness program, which required employees to meet certain health metrics and enroll in this, again, like fitness and wellness, kind of entire program.

And so anyways, it turned out that Washington Post reporter, I think debunked this and it was all misinformation, Safeway had not actually kept its healthcare costs flat, but regardless of that, the Safeway Amendment was included in the ACA. And what it did was it increased the amount of incentives and penalties that a company is permitted to offer

by 10%, so it's now, which meant it was now up to 30% of total premiums or cost sharing. So companies could offer incentives through like reduced premiums for employees if they met a particular health metric or enrolled in a certain employee wellness program. It could be tied to like achieving a certain weight, lowering their cholesterol, some sort of fitness goal. There were all different types.

And I mean, what we talked about towards the beginning of the episode about that sort of very ominous Ford plan. You know, this is, it's the same thing, but again, with the classic, classical Obama style, and it's also replicated among the same thing, but get with the classic, um, classical Obama style and it's also replicated among sort of Obama's equivalents in the UK, uh, of shrugging your shoulders, uh, saying that the state that, um, some company with, with some kind of flashy new piece of technology will essentially come in and square the impossible circle of just sweeping away with, uh, whether that is away whether that is something like the state or at least effective interventions

because they're too expensive or too difficult or whatever. And then we just create this bananza of companies saying you're only gonna be able to afford a cheaper premium if you like starve yourself for a few days to put it ghoulishly. Guys, we're partnering with Aster on their new fat bastard program. It's commonly said that Apple a day keeps the doctor away, but don't worry, there's no doctors left. They've all moved to Australia.

It's much nicer. And also, I, I, I took a look at a report from Deloitte on employer data collection, which basically in this vein, right, says, collect what you want about your employees, but make sure they opt in first. And that, I'll get it. But, right, that you can create value in your organization. But you can create value in your organization by considering, for example, work or happiness. In addition to benefits being of being happier at work, such as improvement, performance, just like in 2023, you have to learn the moral of a Christmas Carol. So check this shit out maybe if they're miserable all the time.

You actually lose money on that. Have you thought about that maybe? I'm afraid actually Bob Cratchit says Have you thought about that, maybe? I'm afraid, actually, Bob Cratchett says, here you ate a whole goose. So your insurance premium is going to be going out. This is a lot of fun. Yeah. But that worker happiness could also improve team work

and social encounters at the group level. Hitachi experimented with improving the happiness levels of its employees using wearables. Yeah, that magic wand. How would Hitachi, that magic wand. How would you tell it she'd do that? Yeah, the company mobile app that offered employees suggestions for increasing feelings of happiness. It seems like all of these companies

just provide the same thing, which is some of the lyrics to don't worry be happy, either text it to you or show on your computer or sky-written over the office, but it all amounts to, please stop crying at your desk. Yeah. It's so funny too, because you think of all these things that would make workers happy, like more PTO,

higher wages, childcare, comprehensive healthcare, right? And it's like, no, we're just gonna keep going down this road. Yeah, we can't do any of that, but what we can do is magic beans. People love beans. And you know, they actually say that Hitachi goes on during testing the psychological capital of workers rose by 33%. So that's something. My psychological capital will pay for that.

That treasure which know the moths nor rusts should evaluate your psychological capital. And profits increased by 10%. Demonst demonstrating how creating value at the employee level had far-reaching impacts on the business, creating value at the employee level. It's the Biden thing. It helps the economy hurt nobody, right? Yeah, meeting Cyberpunk Karl Marx, he's got one like robot eye and he's wearing a trench coat, and he's just handing a couple of his book called Psycho Capital. robot eye and is wearing a trench coat and he's just handing you a copy of his book called Psycho Capital. But you're getting it.

Like, I think this is something where a lot of the scholarship, like, there's kind of a division in the scholarship on employee wellness programs. So there's kind of the HR human resource management, benefit studies, and they're mainly kind of preoccupied with like return on investments. And then you have kind of the other side of the scholarship, which tends to think more about worker surveillance, fatigue of neoliberalism, the kind of use of data collection, possible lifestyle discrimination, and so forth. And what's interesting with the return on investment stuff is, you know, employee wellness

programs, like I said, they're not required. And then there's no real model for how they are implemented because employers can implement them and design them in any way they want. So you could have, you could have like, it could be like the different kind of parts of the benefits maze that the primer talks about around like a point solution and the benefits manager and so forth, work could just be literally like a smoking cessation group or something that meets in person. And so it allows for kind of hard the difficulty then is a lot of these studies, they might find like worker satisfaction at that, but it's like how universal, you know, because they

can be designed in any sort of way, so it's hard to kind of say like in general that this is the impact Going back to your point about like the affordable care act. I mean one thing about the affordable care act was it was an important Victory for thinking about trying to get more people able to get health care and there are a lot of people who Previously it had difficulty getting There are a lot of people who previously had difficulty getting health care coverage that were able to under that policy, but it is an important thing to consider that that policy incentivizes for employee wellness programs, which is another way of saying it tries to create a benefit for the employer to have an employee wellness program.

So what does it mean that as there's this kind of push to expand health care coverage, right, to people that might have had difficulty getting before? There's also this kind of increased like kind of promotion by the federal government, at least through these Safeway amendments and so forth, I would say, to have an employee wellness program too,

to supposedly offset the cost of healthcare coverage. You know what I mean? And so it speaks to the bigger problem of the fact that again, our healthcare is very much connected to our employers in the United States or employment status. You know, it's the, it's that it always must. And again, this is increasing in the UK as the NHS is sort of quietly being dismantled is that your ability to get healthcare is tied to your ability to generate value for

your boss. And that the, I think the point that we've been sort of driving at here, right, that the thing that it's worth sort of hammering home is that the wellness capitalism approach gives you very little wellness in exchange for quite a bit of exploitability. And I think what it also does is, you know, it kind of, the technology is also a way of trying to demand like a quick fix to your problem, meaning like we expect you to kind of quickly get healed or or get well or whatever. And this is a bigger issue, I think, since we're talking about health insurance and so forth, it's like, I'm not a psychiatry expert, but I have friends who are working like psychotherapy

and so forth. And if you look at in the United States, for example, increasingly, therapy might be covered and we saw with the pandemic some of these changes in kind of therapy. So we have a colleague who is at Data and Society, Libya, Goraffalo, who's doing work on teletherepist and kind of the labor politics for therapists doing teletherepist and so forth and working with these platforms. So there are these changes where on one hand it looks like health insurance providers were

willing to make some accommodations around therapy, not always allowing for different, not charging you for certain kind of copays and so forth for a certain period. But what's also happening in the U. the US and also in some other countries is increasingly like this refusal to take or psychotherapy versus other types of therapy. Because psychotherapy is seen as kind of getting at the deeper kind of issues that might not be as quick fix solution. Now you're quote unquote fixed type of therapy, right?

And so you have like these changes of like, on one hand we have this kind of more public conversation about therapy, right? And so you have these changes of like, on one hand, we have this kind of more public conversation about therapy, about mental health, that are seen as these important social advancements to have those conversations, the destigmatized mental health. But there is also this push for kind of quick solutions, quick healing, right?

Quick, you know, well, that you also see being implemented in how like, therapy and insurance is getting entangled. And so in some countries, there's these pushes against paying for psychotherapy through insurance. Or yes, psychonialysis through insurance versus other forms of therapy that are seeing as getting you back to work quicker or getting you back to yourself quicker. And I think that's part of some of the technology stuff too.

Give him cocaine, he'll be back at the desk in no time. What if those voices in his head were telling him to hit those KPIs, baby? And the cocaine has a better legacy in psychoanalysis than like other forms of psychotherapy. I'll say that for her. like other forms of psychotherm, you'll say that for.