Sick Days

Individualized healthcare and corporatized well-being

by Olivia Kan-Sperling

Illustration by Claire Schlaikjer

published March 15, 2018


Of the many protest signs from last week written in that perfect classroom-style, magic-marker-on-cardstock lettering, more than one read: “I’d take a BULLET for your child but PEIA wouldn’t cover it!” Although perhaps hyperbolic, this slogan captures a key frustration of West Virginia’s teachers: while classrooms are often exhausting and stressful, teachers’ health is a low priority. Much coverage of the West Virginia teachers’ strike has singled out anger over PEIA, the Public Employees Insurance Agency, as the catalyst and rallying point for the movement. When asked about the origins of the strike, Kate Endicott, an English teacher, told the New York Times that “they told us that essentially if you weren’t a single person, if you had a family plan, your health insurance was going to rise substantially… I only clear right under $1,300 every two weeks, and they’re wanting to take $300 more away for me.” In return, teachers were offered a one percent pay raise, which would have amounted to only 44 cents more per day. After a sustained strike, teachers have now garnered a five percent raise, a temporary freeze on healthcare costs, and West Virginia Governor Jim Justice’s promise that a specially appointed “task force” will meet by March 15 to find a permanent funding source for PEIA. While this is a welcome change, PEIA has been causing frustration for years; in addition to rising premiums, changes brought by West Virginia tax cuts created sky-rocketing out-of-pocket expenses. As one teacher told Jacobin, “The number one thing was we needed a permanent fix to PEIA. It wasn’t about the money [i.e, salary] at all. It was about the insurance fix.” While precarious and unaffordable healthcare has plagued public sector workers since Reagan, tension in West Virginia reached a boiling point as PEIA started considering more invasive approaches to teachers’ health.

Recently, PEIA implemented Go365, an online and mobile phone health app, as a mandatory part of its “Healthy Tomorrows” preventative healthcare program. In addition to tracking data like daily step-count, Go365 allows users to enter “healthy actions” such as completing a workout, getting a flu shot, running a marathon, or getting a physical exam—all for “Points” that eventually translate into Go365 Bucks. According to the company’s website, these Bucks “have no cash value,” but can be spent at the Go365 Mall on items such as iTunes gift cards, movie tickets, Fitbits, and Go365 workout swag. Unless you’re on Medicare, you can even make Go365 Bucks charity donations to the Red Cross.

Go365 is a subsidiary of Humana, Inc., which offers a spread of corporate healthcare plans. In addition to promoting its platform as “easier, better, and more fun,” Go365 stresses that their work is “deeply rooted in behavioral economics and actuarial science.” Bannered next to a photo of smiling, jogging white people: “You care about your employees. Go365™ can help them become happier, healthier and more productive.” Alongside the near meaningless “rewards” for good health, Go365 promises to reward companies themselves with fewer sick days, lower medical claims, and fewer hospital visits—a belief drawn from a three-year study conducted on Humana’s own employees. As their promotional material puts it, “wellness is vital” because “productivity losses related to personal and family health problems cost US employers $226 billion annually.”

For West Virginia public employees, data from Go365 was set to help decide premium and deductible amounts, and refusal to use the app, as well as failure to accrue enough points, would result in a $500 penalty at the end of the year. Many felt this to be an invasion of privacy, and, amid widespread controversy, by January of this year Governor Justice announced that Go365 would continue in West Virginia only as a voluntary program.

Although West Virginia’s teachers were able to put a stop to the initiative by collectively exerting pressure on their employers, there are more than 5 million workers currently enrolled in Go365—and, according to Humana, 46 percent of employers are looking to switch to preventative healthcare models in the next three to five years. Currently, there is a nationwide conversation underway about the role of the government in providing services, especially healthcare, to its citizens. As the number of public services shrinks, structural inequalities and obstacles to goals like ‘wellbeing’ are elided as more and more responsibility is placed in the hands of individuals.  Go365 works to exacerbate this trend as it explicitly places the responsibility of wellness in the hands of employees.




Whether in a West Virginia schoolhouse, white-collar tech campus, or blue-collar warehouse, this impulse towards individualization is at the heart of workplace organization across the United States—depending on the context, however, this technique manifests itself in vastly different ways on the bodies and lives of employees. Increasingly, digital technologies play a key role in this process of articulating the worker as a singular, nuclear entity—or, in the case of highly mechanized, unskilled jobs, articulating the bodies of workers into discrete, micro-manageable units. At the end of January this year, Amazon was granted patents for a wrist-worn device that tracks the hand movements of employees in order to increase the efficiency with which inventory items are located: the wristband vibrates when a worker reaches for an incorrect item. This is to be deployed first and foremost in Amazon’s warehouses, in which workers are already subjected to comprehensive surveillance, limited bathroom breaks, and 55-hour workweeks. Such technologically-assisted strategies operate under a logic in which employees are fundamentally antagonistic to the interests of employers, and must thus be kept under a constant regime of discipline and punishment. In order to implement such a regime, the individual worker must be made visible, so as to be singled out and corrected when deemed necessary. In this case, the worker is not an individual in any humanistic sense, but rather the possessor of a body that functions as a discrete yet interchangeable unit within a machine.

The unprecedented level of control over employees’ bodies enabled by the advent of biometric data further exacerbates abysmal working conditions. During heat waves or seasons of high demand, it is common for Amazon ‘pickers’ to collapse from exhaustion on the warehouse floor, and there have been cases of death directly linked to the excruciating physical pace of inventory jobs. Moreover, most Amazon warehouses rely largely on temp labor, which allows the company to avoid providing benefits, like health insurance, to its employees. Temp workers are particularly vulnerable to exploitation; while being pushed to higher and higher standards in the hopes of acquiring a permanent position, few actually ever make it to job security, and are instead let go after being pushed to their physical limits. The type of biometric data collected by Amazon’s surveillance technologies is crucial in allowing pickers to view themselves as individualized statistical units on the scoreboard, players with a ranking, thereby inducing them to work ever harder. While this might resemble the “rewards” system of Go365, this game is one that pushes bodies far past beneficial workouts and to the breaking point of physical health. Significantly, maintaining a permanent yet constantly changing population of temp workers precludes any possibility of their unionizing—not only are workers constantly competing with one another, but their total replaceability renders resistance impossible.




In the white-collar world of Silicon Valley, the corporate engines that generated many of these biometric technologies, ideas of individualization and health are mobilized in a vastly different manner. Recently, major tech and finance companies have been leading a trend in ever-more-comprehensive “employee wellbeing” programs. On their ‘Careers’ page, Google boasts that, in addition to healthcare packages that Amazon temp workers or West Virginia teachers can only dream of, many of their campuses offer on-site “wellness and healthcare services, including physicians, chiropractic, physical therapy, and massage services,” plus “fitness centers and classes to save you time and keep you fit.” Such programs are all in the interest of “helping you to be at your best.” Companies like Facebook offer similarly holistic employee-care benefits. For its Seattle campus, Amazon has constructed two massive glass “spheres” containing over 400 species of tropical plants—the idea being that “green spaces can inspire creativity and improve brain function.” While certainly appealing, “well-being” amenities such as these are symptoms of a troubling trend in corporate culture that discourages employees from seeking fulfillment outside of the workplace—a strategy invested not in the health of its employees but in their dependence and loyalty.

White-collar tech workers are not employees, but rather entrepreneurs, intelligent individuals in control of not only their own futures, but those of the whole world. Perfect health, as reached through a series of SoulCycle classes, is in many ways just another facet of the competent individual, a person constituted by a series of good choices (studying hard, getting good grades, attending a prestigious university), who works at maximum capacity, always. Individualism is the corollary of a holistic understanding of the employee. Unlike the disciplinary technologies such companies impose on their laboring underclass—Amazon’s warehouses and Apple’s Foxconn factories are just a few examples—employee wellbeing programs operate under the guise of care. By promising to care for the “whole” employee, a valued individual at their company, tech employers are able to exert a holistic control over aspects of employees’ lives normally outside the realm of the workplace.




Classrooms like those in West Virginia occupy an interesting middle ground between these two sites of labor —neither as nightmarish as a warehouse floor, nor as apparently utopian as a tech campus. Go365 is an interesting point in which these similarities and differences are articulated. It is relevant to consider that Go365 is itself a product of a white-collar office space, and that, in the app, supervision of holistic wellbeing is exported onto a radically different population of workers. In many ways, the program’s marketing rhetoric and aesthetic are reminiscent of the type of free yoga class Google employees might find at their gym, and similarly promise an understanding of the “whole” person who shows up to work, or at least their whole body. But the reality of the lives of many employees is incompatible with this program’s conception of what constitutes a healthy lifestyle.

The manner in which Go365 seems to so willfully misunderstand the challenges faced by workers like West Virginia’s public employees sheds light on the economic gulf that separates the working from the white-collar class. While the leisure time for daily jogging, yoga class, and chatting with a personal health coach might be available to Silicon Valley software engineers, many teachers have to work two or more jobs—and they don’t have a massage table in the teachers’ lounge. Even the complete datafication of the body required by apps such as Go365, which may raise few eyebrows at companies like Google, takes on a different meaning in institutions like the public school system. For educators, step-count would have joined a list of invasive metrics—like students’ test scores, for example—used to evaluate their performance and dole out punishment accordingly. In this type of constant numerical assessment, teachers are inserted into a ranking system with parallels—though also, of course, huge differences—to warehouse pickers’ stats. The fact that teachers are denied the possibility of taking care of themselves with actual US dollars reveals the additional cruelty of the “Go365 Bucks” rewards system. Being awarded an iTunes gift card for going on a run is of little use to a teacher who is barely able to pay rent, buy groceries, and cover health insurance costs. Go365’s seemingly benevolent rhetoric of caring for the whole person disguises a practice of systemic exploitation.

Although Go365 was only a minor concern amid greater frustrations over PEIA, it is symptomatic of the type of increasingly invasive supervision employees are subjected to, whether in the classroom or the warehouse. The biometric surveillance and interventions Go365 enables are especially disturbing in that they slowly increase the jurisdiction of the employer to encompass the whole person rather than just the employee. Moreover, preventative healthcare signals a dangerous shift in our understanding of what constitutes medical services and who takes responsibility for them. PEIA places the onus of health on the employee herself, despite the fact that her exhausting lifestyle, as necessitated by an underpaid, stressful job, may be a major contributing factor to her falling sick. Barred from actual medical assistance by poor health insurance plans and unable to fulfill the requirements of healthy living by virtue of her financial situation, such an employee is thus placed in an impossible position with regard to maintaining her health. This making-responsible of the individual employee, the depiction of health as a direct consequence of poor lifestyle choices rather than systemic injustice, is a different iteration of the same individualism/individualization that permeates the startup as well as the warehouse.

It is important to remember that, in the case of West Virginia, public employees were able to make Go365 voluntary through collective action. As strikers were quick to point out, this small state has a long, hard-won history of effective labor organizing. In fact, the first teacher walkouts were organized by the sons and daughters of coal miners, workers who proudly remember their fathers’ participation in mining strikes. Unionization, which relies on an understanding of shared interests and injustices between members of a working class, is in direct opposition to the ideology of individual choice, individual responsibility, and individual achievement that is the cornerstone of the US workplace ethic as well as US politics. In a time when education is one of a quickly shrinking number of public services, and educators themselves are refused a living wage, West Virginia is a potent reminder of the power of collective organizing. Rather than being normalized, the relatively minor offense that was Go365 instead became a catalyst for a much wider movement: for walking the picket line, rather than the treadmill.


Olivia Kan-Sperling B’20 thinks you need more than an apple a day to keep protest away.