Travis County Commissioners Court
May 20, 2008
Item 14
14. Consider and take appropriate action on request to approve the 24-hour fitness corporate program available to all Travis County employees, retirees and family members. >> good morning judge, Commissioners. We appreciate you posting this on the agenda for discussion. This is a program that we've looked at for some time. It is a -- it is a program open to all employees of Travis County. It provides through 24 hour fitness center a -- a vehicle that employees can use to get into an exercise program, into a fitness program and to help -- in addition to that, to help control our health care costs. I think travis has some statistical information on the effect of -- of that -- that exercise has on weight loss and savings to owe to see health plans.
>> why does this
>> [indiscernible] I couldn't find any current numbers, but basically obesity and overweight costs national health plans over $100 million per year. When I looked at our cost drivers and our current health plan, the number one cost driver is back pain, which can be attributed to being overweight or lack of exercise. Four out of our top six most costly prescriptions are for acid reflux disease, cholesterol, diabetes and a second cholesterol disease. Our two -- two of our top three prescriptions as far as the number of prescriptions written are for cholesterol and blood pressure medication. I think the wellness committee has kind of taken a look at this as one strategy as a part of our overall wellness plan to -- to try to increase healthy lifestyles for employees. We're pleased to let you know that this is going to be the third year that we are able to keep health care costs stable. I know the city of Austin is planning a 10% increase for health care costs for next year. That would be roughly $3 million on our health plan if we had input --
>> could you repeat that?
>> the city of Austin is including an estimated 10% increase in their health costs for next year. They also had health cost increases last year. We have been able to maintain our health care premiums for the same amount for three years in a row. That's bucked the national trend of about 13% per year increase. I don't know if that can continue. We are hopeful with this along with what the clinics are doing, on those programs, employees contributing to healthier lifestyles can at least limit those costs or maintain some type of stabilization in the future.
>> we -- we conducted actually two surveys of employees to determine the interest and utilization of a fitness center. The results, the first survey we had 1167 responses. 83.5% responded that if the corporate fitness program was offered that they would participate if the cost was under $30 a month. This program requires employees who enroll to pay the monthly membership fee, the -- the enrollment fee and the initiation fee is waived. So the employee does pay the monthly fee. It's not -- it's not the county's responsibility. The county would pay a corporate fee the first year is $7,500 of which united health care agreed to pay 3,000. The second year would be $5,000 fee. And that's -- that's a dollar of -- of an employee as far as the investment in health care. With -- within the survey, 75% of the respondents indicated that if there's a waiver of processing fees they would join. 95% said if there was the availability of a fitness center that they would participate one of the major factors was location and cost. The location was important. 4 hour fitness has six locations now. Planning two additional locations, one in Pflugerville, one in Cedar Park that will open sometime after the first of 2009. One of the conditions -- of the conditions that we were concerned about was accessibility to all of our employees. A centralized center would not benefit employees who work in the outer areas so having a spread of locations was important, that's one of the factors in -- in recommending a fitness center. Posted in house. Whether this is a good program or not will depend on the participation. Again based on the surveys, the employees have indicated that they would participate. I think if you looked in the audience today you will see there's a -- there's a broad array of employees, different departments who have expressed interest and are interested in having such programs. I will address dr. Stewart to address some of the clinical benefits of having formal corporate fitness center.
>> well, first of all, I think most of us acknowledge that exercise is related to improved health on multiple different levels. And looking at health care costs in the long term picture the way the county does, we see that prevention of diabetes, of high blood pressure, of high cholesterol of course saves a lot of money in treatment of those diseases, both in the pills that we take and in treating the complications. Working with a corporate center such as 24 hour fitness, will allow us to get high risk employees -- they have a higher risk of those diseases and complications partnered with a trainer and really get them exercising in a way that they could potentially reverse their disease or stop having to take medicine for that disease. Because it would be controlled through lifestyle modification. I feel that a lot of people would like that option very much. May not be comfortable going to the gym by themselves or have the motivation to do that by themselves. Having a trainer opportunities the way we are discussing with 24 hour fitness will very much I think encourage some of our people who are very much at risk for complications from serious diseases to take the personal initiative to fight those diseases with exercise.
>> I think page 9 of your backup shows the type of report that 24 hour fitness can provide to us on utilization, so we can determine exactly what that is. And use that as a benchmark and a measure. In addition we would be looking at reduced bmi, as doctor stewart said.
>> body mass index directly related to a number of health care issues, musculoskeletal pain, knee problems, back problems, aggravated by carrying too much weight. Cholesterol problems, expensive to treat, also causes heart attacks, strokes. Those risks are those diseases are less frequent when a person maintains a normal body weight for their height or a normal body mass index.
>> we would have measures, one is enrollment, two, three, measurement of body mass index, the control of diabetes through the a 1 c test, weight loss program, among the measures. This -- this program is -- is one that -- that -- that is kind of like the third leg of the stool on a wait lost managed program. If -- if a patient goes through the clinic, they get medical screening, they get dietary counseling and this would be the third leg, the exercise or fitness point. The fees would be for an employee 28.99 a month. For a second person in the household, 17.99, for a third person 12.99. And there's no contract. You enroll or you can drop as you wish. And again is open to all employees, not just those that need a health plan. The annual corporate fee is an investment of $1 for each employee.
>> I have three questions. The first is what number of enrollees do we believe would justify the $4,500 county investment is what we are looking at the first year. What's the magic number for us to justify that investment?
>> I went online, judge, today, just compared what the -- what the enrollment fees are without being on this program versus -- versus the reduced cost or the no enrollment fees for Travis County. If -- if you had one employee plus a spouse, the enrollment fees would be under the -- under this plan would be 0 costs. They would $78 without the plan.
>> okay.
>> if I took the $5,000 enrollment, one annual fee, divided by that $78, as long as we had at least 64 employees, combination of employees plus spouses join the plan, we would generate some savings compared to what they would pay otherwise. In addition to that if we looked at the current rate for this plan versus just walking in under the street, the employee plus the spouse would save $180 plus tax per year.
>> okay. Now you answered another question. That's good information.
>> trying to think ahead.
>> good information. Let me move to my second question then.
>> I?m sitting here thinking if I were john doe resident I would not want the county to pay the 4500 bucks until I saw that a significant number of county employees were interested enough to sign up. So what -- what's that number for us? If I say okay I?m supportive, but I really want to know that the employees who -- who supported -- who supported the program via survey, support it enough to go down there and enroll, what's a good number? 100? 75?
>> well, there's -- there's two ways to answer that.
>> let's try a number first. Then we will go to your two ways.
>> okay.
>> 450 -- well, 450 employees.
>> how many dan?
>> 450.
>> all right.
>> okay. That's a high number.
>> that is. Even I was not that optimistic.
>> that's the hard dollar. Now --
>> what if we say okay let's get 100 to sign up, then that will be real support. Because a third question is -- is the second year we go from $7,500 to 5,000. And -- and I guess the carrier for united health care may support it the second weeks may not.
>> we can -- second year, may not.
>> we can certainly ask them to.
>> at the end of the first year, though, we will know how many in fact participated. Let say we are unhappy with that number. Do we have a way to get out of that contract?
>> yes, an annual contract.
>> so at the end of the first year, if we don't like the results, we can simply notify 24 hour fitness, thanks but no thanks for the second year.
>> that's right.
>> okay. Seems to be to be a reasonably modest investment, but I do think that we owe the program a look-see in terms of and I?m willing to accept a figure like 100 employees.
>> I like that figure. But what you have to understand, if 100 start out, two months later it is very unlikely that we have that same hundred, but our results may be zoo good that it's 200. The -- may be so good that it's 200. The bigger the number, I think the bigger the number at the end of the 12 year period is the way this normally works. Unfortunately I have a bad history of -- of club membership because I have belonged to one two or three years, I never went, but I did go the first three months. So I mean I assume we can educate employees, try to motivate them and give it a try.
>> I think we can do that. We can do it through support groups. Groups that go to fitness centers tends to go longer. There's some programs that we can -- we can promote this with.
>> the other thing that keeps employees going is for it to be easily accessible as you mentioned before. So there are -- there are centers in all like south, north, east, west, downtown and then you mentioned the two that are -- what was it, Pflugerville and Cedar Park. So the -- so the conveniences there is kind of built in, we think.
>> yes. Yes it is.
>> I think one -- the fitness clubs that are open 24 hours, that would accommodate all of our staff that work around the clock. If the gym closes at 8:00 or 9:00, Travis County employees get around that time, they could go to the gyms and work out on their own schedule.
>> 24 hours, right?
>> right.
>> it's accessible, tour of duty, work schedule or any other schedule they have to adhere, it would be available 24 hours basis, seven days a week. Is that correct?
>> yes.
>> all right. I?m sorry Commissioner.
>> the other thing was that I wanted to address Commissioner was the safety of employees. Do we want to make sure that people know that they need to go in groups, not go by yourself. Just to make sure that you are alert about your surroundings. And -- and we don't want to put anybody at risk either. For their safety.
>> middle of the night.
>> if you go later or even in daytime around here crime happens in daytime. As well if we are not alert to our surroundings. I would want that issue to be addressed. To make sure that nothing happens to people.
>>
>> [indiscernible]
>> we can certainly do that.
>> and there are child care centers on site.
>> right.
>> where is the one in south Austin?
>> william cannon.
>> and mopac basically.
>> Commissioner, were you through.
>> go ahead.
>> I have two or three questions. I see that there has been surveys conducted and it appears from the surveys if you can just basically let the public know what the results of those surveys were as far as utilization to -- maybe we can get to that number if we can base the results of the two surveys conducted, given those numbers of the thousand, surveys, that -- are you using that as an indicator to suggest that, yes, yes, yes, we will use it -- use this facility if it's made available. I guess that it's -- looking at this, is that the same reading that you are suggesting as far as looking at the numbers, tying down the number of actual usage, con continuing getting on the -- contingent on the results of the survey that was conducted as far as using this facility. So is that part of the -- the numbers as far as the usage of this 24 hour fitness center.
>> pardon me.
>> it did come off the survey.
>> okay.
>> number two is that -- is that we talked about a tier structure as far as -- as far as the first person being $28.99 per month, blah blah blah. Then down to the second person, 17 something, then the third person 12. What happens after the -- after the fourth or fifth person, some folks may want to take the entire family, may be more than the first two, first person employees, second person, then third, it stops there. What happens to the fourth, fifth, sixth person.
>> 12.99 each.
>> so the 12.99 is the minimum, is that correct?
>> yes, sir, that's right.
>> all right. Thirdly, I would like to know this: is there any other model that has been embraced by a governmental entity doing such -- as we are looking at here today? Is there -- is there a track record of any of the usage of this type of -- type of innovative type of approach?
>> there is.
>> if so, what is it and what are the results from that? I?m trying to look to someone else.
>> in my research, there's a number of cities and counties that are doing programs.
>> okay.
>> I can compile some information and put it, you know, share it with you. I have got some information. Most of the stuff is being done on the private sector side. I think there are probably -- probably maybe a little bit more proactive in this area in the public sector just catching up. But I found a county in iowa that's a small county in iowa that's greatly reduced their health care costs by participating in wellness programs. The city of roll land, michigan. Holland, michigan. I believe the school partners with 24 hour fitness or did at one point in time, aisd, I know a lot of major employers do partner with gyms and have success.
>> I guess the way I?m understanding it, as far as the backup is concerned, it suggests that -- that the out of pocket expense for those employees that are available would be maybe like a payroll deduction? And if that is the case, all of these particular accounting features of this program has passed the mustard or has been embraced by the county auditor, all of those other folks that handle this particular situation, is that correct?
>> Commissioner, it won't be payroll reduction, it will be hch, withdrawal from one account or another.
>> I?m sorry.
>> it would be a withdrawal from an employees' checking, savings account or credit card.
>> it won't be payroll deduction.
>> no. That's one of the questions we did ask in the survey and the majority of the employees came back and said they wouldn't object to that.
>> they would object to that.
>> they would not.
>> I misread that, that's my error. I?m glad that I asked the question.
>> employees that were agreeable -- employees were agreeable to having their membership, forly membership paid that way.
>> checks and what else?
>> automatic withdrawal from their checking or savings or credit card.
>> oh, checking, savings or credit card.
>> yes.
>> okay. All right. Thank you for that correction, because I misread that. Part of the survey stuff. So I just misread it. Lastly, since we have been very aggressive, this Commissioners court, and looking at the way we can handle and deal with our health situations here, along, you know, with the wellness clinic, which I think is the state of the art, I don't -- you know, what we have in Travis County is very unique, self -- self-insured, wellness clinics, I think folks probably around the country and the state of Texas are looking at what Travis County is doing. As we move forward in trying to address some of the health concerns of our employees and also their families. My question is -- at what stage of this particular endeavor, if the court decides to support it, would we have any type of indication of -- of participation? What -- where up front, first quarter, second quarter, whom would we have some type of -- when would we have some type of indication getting back to the court to let us know what we're doing after this particular program if the court decides the support is initiated.
>> I think a reason period of time would be 90 days to develop the utilization patterns and then we could provide monthly reports after that that would give an answer to your question on utilization and enrollment. It would take probably how long would you say before any clinical data was available?
>> pardon me.
>> I would say about three months usually to see it trend downward or upward in cholesterol or average blood sugar to be tested about every three months. For there to be clinical data it would take at least three months to see a difference.
>> okay. That's very important. Okay. All of it's important, but that's another key point. That's my last question at this time. Thank you.
>> I will be as brief as I can. The judge and the Commissioners have gone over a lot of this plus alicia sent me a very comprehensive response to questions that I had, I really appreciate that. My questions really go to questions for collaborating for the success of this program. I?m wondering if we couldn't perhaps partner with t.n.r. Through perhaps addle in creating a car pooling option from the various locations either at lunch time or car pooling options from the 24 hour fit tons work in the morning. Fitness to work in the morning. It could go a long way to reducing our overall traffic and parking requirements, as well as creating an incentive to go to 24 hour fitness at mornings or lunch time. I want to commend the wellness program for putting this together. This is a first step in what I think could be a collaboration for really, really, innovative wellness on site as well. I know the wellness committee is looking at this. But our on site or around site food choices which are very limited in the downtown area, specifically, and at the airport boulevard location specifically, we don't have a lot of options for truly healthy food as well as I noticed that -- that very high percentage of our employees are walking as their major form of exercise. And I would love to see our facilities management incorporate amenities within our buildings to support that as well. Airport boulevard seems individual for a trail system to be developed and our development of that campus so that folks can utilize a really nice walking trail both the neighborhood and our employees as well as the facilities to -- to support that. During the run tex challenge, they were giving out little moist towelettes for folks. As a bike rider often I book to work in the mornings when it gets too hot I won't bike not because I can't stand the heat but because I will be sweaty and stinky for the entire day. I would love to continue biking through the summer, but it's really for the an option without the facilities to support it. So this is a really wonderful program. And I would like to continue to work with the wellness program, do anything that I can do, to collaborate between the utilities, h.r., hhs, the various other departments to collaborate for the success of a really comprehensive wellness program for our employees.
>> Commissioner?
>> Commissioner eckhardt, you live so close here we might be able to use your showers.
>> I have thought about that. I could bike to work, then bike home and shower and then drive to work. That seems to be --
>> [laughter] really counter productive.
>> let me first say that I -- that I agree with sarah in that I applaud the wellness committee's efforts and continued -- continued efforts towards, you know, health and especially as it relates to our employees. When you came to see me, dan, and I -- I don't know travis came, the one thing that I stressed the most was -- was you need to get a program like this out in the public. You don't need to be asking the employees. It doesn't surprise me that the employees, I mean, would respond to this favorably, I mean, I think that's something that I would have figured would have come back the statistics, you know, that have shown to be of pretty positive approach with -- with wellness. But let me recall what happened to this court with bariatric surgery. It was ugly. Why was it ugly? Because we couldn't put on a bumper sticker what we were trying to do with county employees. The public is the one that needs to weigh in on how do you spend public dollars. That's the reason that I was so interested in going before, because there are a number of talk shows that have a lot of listening, you go and you take this program, you say this is what we're wanting to do or what we think that we want to do, but gives an opportunity to educate the community about -- about obesity and about the statistics that prop up, if you will, the need to look at innovative ways and into things that, you know, because after all, I mean,, you know, we are 4500 strong family, I mean, Travis County employee-wise. Since we are self insured, you know,.
>> yep.
>> but the average everyday public doesn't really connect those dots that way, I mean, because, you know, all, you know, what happens with media. Media goes out and asks the simple question are you for public dollars being spent on giving overweight people surgery. That was about 92% against. A lot of it is how you couch the question. You can't be afraid of what the answer is going to be, I mean, if you are then you are probably not going to like some of the results that's going to happen. And all of us, I mean, you know, we have a direct feed from the public about -- about why you are doing, why you are spending public moneys on some things. I don't think that we did that, did we? We didn't talk to -- try to go to talk shows, about public service announcements we really want to get some feedback. I still think that that is something that we ought to do. Just to see what the public says to us. And give us the opportunity to educate people because some people want to hear it, about oh, okay why you are asking to do that. I think we can be pleasantly surprised by some of the response. Again not to be afraid of some of the responses that we are going to get which we know people will just not be supportive of public dollars being spent on things like this. If we do that, we get -- we get the negative, I mean, the overwhelming negative, I mean, I don't think that we ought to stop from trying to do something like this. Number one I think that we probably can approach 24 hour fitness and I?m not so sure that with -- with a pool of a potential 4500 people that you can't really cut a deal with 24 hour fitness that says how about -- how about our family, you know, we -- we are trying to cut a deal that if you will give us these rates, then we will -- that we will promote even if we have to go through purchasing or whatever, I mean, put it out and say what we are looking for is trying to deliver the potential of a 4500 person reservoir here of potential clients because that's what they are looking for. I mean the health clinics all know that -- or the -- or the fitness centers are looking for ways to have a connection to -- to an organized group of people. I think Travis County, I mean, has 4500 people that we could probably do that with. So I would ask that -- that, you know, after we do this education program, I mean, on the -- through psa's, public service announcements and the talk radio show, shows, that -- approach 24 hour fitness. The other thing that I -- and if we can't get the waiving because y'all my only receipt since on this thing is $4,500 from the county. I think it's a great way to try to get in and offer something to the folks, let's not deal with the public on us spending public dollars to do this, I mean, if we can't get them to negotiate with us in that light, I think perhaps they probably would be willing to take the $3,000 or whatever it is from united health care and says that's fine for us. Your fee is $3,000 and united health care is the one that pushed the $3,000 up. If they wouldn't, if theory not willing to -- if they're not willing to do that, then I think that we should go to the participants and if it's 4500's, we need to find however many people are going to participate in that thing and divide that number into the $4,500 and say there's an initiation of, you know, whatever the amount of dollars, $10 or whatever it is. I mean depending on how many people you get. But y'all I am very apprehensive about going out and spending $4,500 of Travis County taxpayers dollars, I mean, even though, you know, we can kind of get around that by saying these are fee that's we have obtained through the health care, because that's where we were going to spend our $4,500, that's where we were going to get it, right? But again the public doesn't understand that. It kind of comes out of the county coffers and unless you -- you can't put that on a bumper sticker, I mean, now whenever I talk on the bariatric surgery, talking through being self-insured and how many dollars we were spending on people that had -- that were morbidly obese, and that we really felt like we had the opportunity to cut our costs, you could see the needle kind of moving with people on the resistance, you know, where the needle was over here, highly against. You could see people go oh, well I didn't know that. Well, that makes sense that you do that. And well I mean I might be willing to take a look at that. You can get people to be accepting of something that we are trying to do but you have got to educate them. It's hard to educate people when you have got 800, 900,000 people in this community that you really want to know what you are trying to get done. I do think there are ways to still get this thing done where none of us have to deal with the push back on our spends $4,500, I bet you we can cut a deal with whatever united health care wants to pick up, that's the most that we can get you with an up front fee. Let's see if we can do that. That's my opinion.
>> how long have you all been working on this?
>> about two years.
>> 75% of the people that spent me e-mails in opposition to bariatric surgery said try diet and exercise. This is exercise. How does the 28.99 compare with what the other fitness centers charge?
>> that's -- that's pretty much the going rate.
>> comparable, it's 28.99. If we walked in the door it would be 29. The real savings would be if you added a spouse or family member, I think that you save $150 a year. The enrollment fee.
>> that's good enough.
>> what would be the source of funding for the $4,500.
>> two possible sources, the health fund and the second would be the -- the wellness budget. The wellness budget.
>> okay.
>> are you able to enroll 100 before you -- before you deliver a $4,500 check?
>> the -- the agreement that we have been able to reach with 24 hour, we negotiated with --
>> [indiscernible] bring this down to the limits that are now before you. They would want the united health care $3,000 and in 30 days the balance of 4500 would be due.
>> can we get 100 enrolled in 30 days.
>> we certainly hope so.
>> united health care is willing to deliver 3,000 up front?
>> yes.
>> > do you need a one week extension.
>> I?m not going to feel differently next week than I do about it right now.
>> judge. I?m supportive of this. I think about the early days when we were struggling with -- with one ever our health care -- one of our health care providers when I first came on board here. And I was very displeased and very -- very not satisfied along with others because we were engaged in a contract that -- that for this particular health provider that -- that we had to -- to wait until that contract actually expired as far as our relationship with the self provider. But when that particular contract expired, this particular court did a very innovative thing. And that was number one to become self funded. Self-insured. We got a carrier, united health care to work with us to provide our health care needs for the employees and their families of Travis County. I don't -- I don't feel any -- any guilt in that one way shape, form or fashion. Not only that, we -- we end up going to the next step, what was the next step? Well, the next step was that we -- was that we said listen, we can go -- we can do better than that. And -- and we can also provide -- we can also provide extra benefits whereby we will be able to -- we will be able to provide wellness clinics where -- where we can have our employees to go and visit our clinics and not only that, staff these clinics with the proper medical professionals that we have -- that we have on board there. So -- so that has been quite a bit of -- of -- of activity, innovation and it has saved taxpayers money because of the fact of this type of
>> [indiscernible] and of course we have been able to keep our premiums, a lot of healthy situations been monitored, so we have done a lot. And -- and in this particular arena. And if this particular -- judge, when you make your motion I would like to second it if you make the motion to support it. I want to be on record as being the first, one of the first persons to be involved. So now you are looking at 99 instead of 100 if this thing passes.
>> [laughter]
>> judge, let me just kind of do a little follow-up. Since we can stop after the first year, if we don't see success, which means that we are going to be getting reports showing us the results. We sign up 100 people, we report back in 90 days about -- about, you know, the participation and obviously people are going to have to continue to participate to see some results of losing weight and improving health. Then probably at the end of the year we will see more results, we will want to see more people sign up. And not just the 100, we can build off of that. Then in terms of responding to the public, yeah, we need to be able to respond to not only do we raise taxes, but we have to account for the money that and how it is spent. So in order to -- you can give us the kind of information that we need to -- to give to the public when we are asked about it. And, yeah, they are healthier and yeah they are responding better to your issues when you call on us to serve you. And so -- because we feel better. About ourselves. With that kind of agreement, I think that I can certainly support this as a -- as a pilot project which is what it sounds like. If we don't have results at the end of that first year, sounds like we can back off and I think that's a fair trial.
>> but we have spent $4,500 to do that.
>> well, hopefully we have improved doubled that in terms of delivering service to the public.
>> I think the 4500 investment in a one year trial to see what the health outcomes are in regard to weight loss, body mass index and then working with the clinics to quantify the -- the financial benefits of -- of that kind of improved outcome, with that subset that applies, I think $4,500 is probably a fairly good investment to see if -- if the program works.
>> [one moment please for change in captioners] down to 99, judge. 99.
>> so I?ll add two to that.
>> I wish I would have taken you up on having an extra week because had I known that we were going to do it this quickly, I bet you we can get a better deal than $4,500. And even though we've been working on it.
>> I?m okay with that.
>> I mean, I?ll bet you that we can find somebody that will work with us in this community that will not charge us $4,500 to have access to our reservoir of 4500 people. I?ll bet you that we can do that. And get to where we all -- I mean, I want the people to have the ability to do this. That's not the issue to me. But I do think that we can do it without having to spend $4,500 out of our -- because I think that there are going to be some things that will get in front of $4,500 of spending over this. Because we are going to do a budget that there are going to be a lot of asking, and I?ll let you that there are people up here that say I wish I could do that again. I realize that we probably could do that with a lot of things, but I do think that we can -- given the fact that if somebody knows that, hey, Travis County really wants to do this with their 4500 employees, I?ll bet thaw we can do it without $4,500.
>> what about this. If they've been working on it two years, I hate to go back to scratch one. But what is to keep us from over the next 12 months trying to figure out if we can get a better deal, and if we can, we do it? What if we can negotiate a better deal with 24 hour fitness 12 months from today if we think we can.
>> and to continue to shop it. If gold's gym comes in and sees that 24 fitness has cornered the Travis County market, they may come in and offer us a deal. I think the $4,500 is a good pilot. I would suggest in further negotiations that we negotiate a better cost for personal trainers. I think that the clinic might have a real opportunity here in hooking people up, essentially extending the clinic's reach by hooking people up with trainers that will help them with their diet and workout to make it as productive as it can be. Because the trainer fee can be cost prohibitive for a lot of folks.
>> the numbers can drive a whole lot of things too. If
>> [overlapping speakers]
>> we're going to keep building off of the 100 people that we sign up. We need to keep signing more people on.
>> well, bear in mind that our 4500 people aren't any different than the other 900,000 people in this community. In the write-up it's very clear, and if you know a little bit about how fitness centers work, they work because they realize that most people won't go. People go because doctors say you've got this issue and they get energized to go out. And when it's 90 to 120 days, you start seeing that usage. Now hopefully, which is the reason why you want people to have some skin in the game, you want them to pay. You need some incentive to use it. But I just really -- my resistance on this thing is $4,500 that I don't think that we have to explain to people in this community why we need to spend it. And I don't think that we need to negotiate it and wait for a year. Maybe if we could wait for a week we might be able to find somebody that's willing to do this thing and say we're not going to spend $4,500.
>> Commissioner --
>> can I address that particular concern? Let's go ahead and do the math. $4,500 is one dollar per employee. In response to the judge's request, what would it take for us to break even, my response would have been one employee. If you get one employee to go in and exercise and lose weight, and the cost of the diabetes medication, cost of it, you could save the money at least on the health care.
>> we had the same argument with bariatric surgery. We could statistically show you if you would just allow us to take one person -- it's bound to work out that one of the 15. That wasn't the issue we had in this community. The issue with the community -- the issue with the community is are you willing as a governmental entity to spend these kind of dollars on those kind of things even when you know that you're self-insured and that from an economical standpoint you can argue it and you can justify it. But if you have a community that has a severe push back on what you're doing with tax dollars, it's hard to overcome that. And I think there's a way to overcome it. If we were to go out -- I think that these are things we need to have. Two or three of you go to the show, take the doctor, have the people call in so you can have plausible responses and let people see that because that's what we're really dealing with here. It's not a matter of do we think that we know that we can justify it from a cost standpoint because we probably can. We could have justified it from the bariatric surgery deal. We just couldn't get over the hump of explain to go people in this community about what we were doing with public dollars.
>> one moment. Although the analogy you're making with bariatric surgery is inept, because as the judge said, so many people's response to bariatric surgery, they said try exercise and diet and I think that's exactly what this is. I think in term of if you were to take a poll today in the public -- and this is speculation, but I think it's probably pretty accurate. If you were to poll the public today and say what do you think someone who has health problems related to their weight should do, go get surgery or go join a gym? I?ll bet you the response would be go join a gym. It's far more accessible in our society than bariatric surgery. So I think the analogy is inept.
>> wait a minute, lisa. That's fine. Maybe it's not an apples to apples comparison. In my opinion, the public is also saying, yes, I want you to go to a gym. Yes, I want you to stop eating the things that you shouldn't eat, but I want to you do it on your nickel. I want to you do it -- just like the rest of us do, we don't have public dollars that pay for those things. Even though they could probably justify it if we could get up and let people know why we're doing it, but that is not the issue as far as I?m concerned.
>> we have public dollars paying for our health care, however.
>> I understand that and I couldn't get that point over to anyone.
>> it's between 300 and $500 a month in -- a week in reimbursement. Thank you very much.
>> all in favor? Show Commissioners Gomez, Davis, eckhardt and yours truly voting in favor. Commissioner Daugherty voting against. Thank y'all very much.
>> [ applause ]
>> I want you to remember now it's down to 99. 99. All right?
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Last Modified:
Wednesday, May 21, 2008 8:51 PM