Maya Rockeymoore Cummings takes a look at FDR's efforts on universal healthcare for insights into today's debates. Could wellness insurance be on the horizon?

It is perhaps ironic that our country is at the precipice of creating a national healthcare system a full 74 years after President Franklin D. Roosevelt first tried to get universal healthcare passed, as a part of the original Social Security Act of 1935. While many people today aren’t familiar with this important history, FDR’s efforts provide important guidance for today’s healthcare reform debate.

Prominent leaders in the national healthcare debate agree that prevention and wellness need to be core components  of healthcare reform. However, the proposals that have been most discussed will not provide vulnerable populations—those who experience the most sickness and death as a result of preventable chronic diseases—with equal access to prevention and wellness services.

For decades, larger corporations have been encouraging their employees to participate in wellness programs. Thanks to their efforts, we now know that wellness services, such as subsidies for gym membership and tobacco cessation and weight management courses, are a way to improve the health of workers while reducing healthcare costs.  Given the effectiveness of this approach in the private sector, it makes sense to make sure that many more Americans gain access to these important services.

However, providing large employers with tax credits to support their work site wellness programs (a commonly touted approach) will not give lower income, small business, and blue collar workers who do not work for these corporations access to wellness services. Similarly, proposals to expand evidence-based community prevention programs do not have sufficient scale to serve broad swaths of the American public.

Most people are not aware that when FDR’s effort to secure universal healthcare failed, he created an ad-hoc group called the Interdepartmental Committee to Coordinate Health and Welfare Activities. The ostensible task of this group was to study existing government-sponsored health and welfare efforts to figure out how to coordinate them. In actuality, they were seeking ways to add a national health plan to the Social Security Act.  Issued in 1938, the committee’s full report included a recommendation to expand public health and maternal and child health services under existing titles of the Social Security Act.

It’s time for our nation’s leaders to revisit this idea by creating a “wellness insurance” program as a part of the Social Security system. For a nominal increase in the Social Security payroll tax, workers would gain access to approved wellness services such as  nutrition education courses, gym membership, weight management courses, smoking cessation plans, disease management courses and maternal and child health education courses, to name just a few services.

Beneficiaries and their families would qualify for wellness insurance based on an accepted formula tied to their Social Security contributions. In order to ensure quality, companies that want to provide wellness services to Social Security beneficiaries would be required to become certified vendors. To help generate additional revenue, these wellness providers—who stand to substantially benefit from this program—could be charged a certification fee.

Furthermore, the adoption of a wellness tax credit tied to wellness insurance utilization rates and health outcomes would create an economic incentive for Americans of all backgrounds to eat healthier and be more physically active. Under this part of the plan, individuals and families who meet specified yearly utilization requirements and can demonstrate progress towards health goals would be eligible to receive a wellness tax credit that could offset their income tax liability. This tax credit would be refundable so that individuals and families without tax liability could also be rewarded for healthy behaviors.

A web-based electronic system could be set up to facilitate payment to wellness providers as well as the transfer of individual/family health data between wellness providers, beneficiaries, the Social Security Administration, and the Internal Revenue Service. All applicable privacy rules and practices would be followed.

The rationale for this plan is straightforward: by creating a wellness intervention based on social insurance, many more people will have access to the supports that they need to make healthier choices. It is anticipated that this approach will reduce the incidence of preventable chronic diseases and lead to increased healthcare cost savings. It will also likely result in increased Social Security savings because fewer people will seek disability and survivor beneficiaries as a result of preventable chronic diseases. In addition, seniors in better health may have fewer out-of-pocket health related expenses that would provide them with more economic security as the age.

Ultimately, American workers and their families who are guaranteed access to critical wellness interventions will be empowered to make healthier lifestyle choices that will reduce their health burdens and costs in the future. This would be good for individuals and families and good for our nation’s fiscal health.

Braintruster Maya Rockeymoore Cummings is president and CEO of Global Policy Solutions.