Carrots, Sticks, and Health Care Reform — Problems with Wellness Incentives

Abstract

Chronic conditions, especially those associated with overweight, are on the rise in the United States (as elsewhere). Employers have used both carrots and sticks to encourage healthier behavior. The current health care reform bills seek to expand the role of incentives, which promise a win–win bargain: employees enjoy better health, while employers reduce health care costs and profit from a healthier workforce.However, these provisions cannot be given an ethical free pass. In some cases, the incentives are really sticks dressed up as carrots. There is a risk of inequity that would further disadvantage the people most in need of . . .