Ezekiel Emanuel is a physician, presidential advisor, and principal architect of the Affordable Care Act (aka Obamacare), who is most recently famous for his self-promulgated guideline on when Americans should aspire to death — age 75, in case you did not read his essay in The Atlantic. Dr. Emanuel’s latest confession is that American adults — most of whom are generally healthy — do not need to get annual physical exams.
It’s ironic coming from someone whose legislative handiwork promotes exactly the opposite of what he is now saying the best evidence shows people should not do. When Dr. Emanuel helped to draft the ACA, there was no more evidence than there is today about the benefits of annual physical exams for generally healthy people. Dr. Emanuel admits in his Times essay that studies from as long ago as 1963 have shown their futility.
When drafting Obamacare, Dr. Emanuel was apparently more than willing to ignore the paucity of evidence and codify these wasteful services in two important ways. First, it requires health plans to cover them at no cost to the patient, which unfortunately perpetuates the idea that medical care is free. Second, it encourages employers to launch workplace wellness programs that send employees for physicals even though many people don’t want or need them.
Taken together, Dr. Emanuel’s codified prescriptions, which he now disavows, likely account for at least 45 million useless office visits each year. Assuming average reimbursement of around $150, this means at least $6.7 billion and countless hours of physician and consumer time wasted annually on services that are meaningless and frequently harmful because they can lead to more visits and highly profitable testing for nebulous findings that often find nothing. Provider economics are, in fact, the only reason to promote annual physicals for generally healthy adults.
The victimization of employees in workplace wellness programs is especially acute. Employees who don’t want to comply with their wellness program’s dictates, of which the annual physical is preached with near religious fervor, must face their employer’s penalty for non-compliance, which, in the case of Penn State, for example, was $1,200 per year. At a time when wages are stagnant, this is a tall hill for many Americans to climb.
Dr. Emanuel’s new prescription — don’t get an annual physical — is an inadequate course correction. The ACA’s provisions on annual physicals need to be acknowledged as wrong and rewritten. Annual physicals should be treated no differently than any other medical service and subject to copayments and deductibles. Workplace wellness program sponsors — the greatest offenders in the category of subsidizing worthless uses of the medical system — should be told that they cannot promote any preventive clinical service to employees that does not get an A rating from the U.S. Preventive Services Task Force.
It should be relatively straightforward, and an uncommon breath of fresh air from Washington, to eliminate policy support for a service that is useless, free at the point-of-purchase but costly and wasteful in the aggregate, and (in the case of many misnamed “wellness” programs) subsidized in such as way that people who don’t want it are coerced into getting it.
Vik Khanna is the author of Your Personal Affordable Care Act: How To Avoid Obamacare. Vik thanks Al Lewis, co-author of Surviving Workplace Wellness with Your Dignity, Finances, and Major Organs Intact, for his comments in drafting this op-ed.