EVERY SPRING IT’S the same ritual, and every spring it makes me the same kind of crazy. It’s the annual crisis of conscience called the Healthy Incentives survey.

If you don’t work for King County as my husband does, you may not know about this maddening public sacrament. People insured through King County spend the first six months of the year in rabid pursuit of the coveted Gold Status, which so reduces one’s out-of-pocket health insurance expenses that it’s worth the rabid pursuit. So reduced that some 90 percent of employees sign up.

The program consists of two parts: First, a Self Assessment, where participants submit their weight, drinks per week, cholesterol levels, body mass index, and other conversation killers. The program shoots back a verdict (“You’ve earned Silver Status on your insurance rates!”) along with a menu of personal improvement regimens to fulfill in order to qualify for Gold Status. Choose a 10-week regimen—working out, eating healthier, destressing, the usual suspects—and this becomes the second part: the Personal Action Plan. Complete the plan; snag the lower-priced Gold Status.

One records one’s statistics and progress on the honor system—and therein lies the rub. Four years ago when King County became one of the nation’s pioneers of Healthy Incentives, the new paperwork and new deadlines took my husband and me so by surprise that we madly logged all 40 days’ worth of exercise entries the night before it was due. Let’s see…what day was that beach run? Was that before or after the long bike-ride day? Sure we were missing the day-by-day value of the program—but just getting the worksheets completed without a second to spare felt practically aerobic.

The next year we were more prepared—and shrewder. The night before the deadline found us horizontal on the couch, Kahlua milk shakes lubricating the “memories” effortlessly. “Let’s see…if I ran 10 miles on April 11, I wouldn’t be likely to run for a couple more days,” my husband mused. “We’ll make April 12 an easy gym day, shall we?” Slurp. Belch.

Don’t get me wrong—it’s not like we…lied. We both work out, enough to fulfill the spirit of the action plan, if not exactly the letter. “It’s just like this,” my husband blurted to a colleague over beers a few weeks later. “When the plan is so easy to bluff your way through—I gotta admit, it’s difficult to take it seriously enough to tell the truth, let alone change my behavior for.”

The colleague, an alum of the department that managed the plans, burst out laughing. “You think we don’t know people lie?” he said. “We know people lie!” Even former County Executive Ron Sims lied on his wellness assessment, famously admitting to his staff that he knew it was time to commit to a fitness regime when he fudged several pounds off his weight and the thing still pronounced him fat.

“The thing about this plan,” my husband’s coworker concluded, “is that it works anyway.”

Since King County became one of the first employers in the country to link out-of-pocket expenses with participation—in other words, one of the first to reward employees for merely logging attempts to live healthier—those employees have in fact become healthier, in 12 out of 14 areas. This the authorities determine by comparing insurance claims data (anonymous, of course) with wellness assessment responses.
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But here’s what makes those results really compelling. King County’s employee base is so unusually sta-ble—insert crack about bureaucratic deadwood here—that the population as a whole is getting older every year. Yet improbably, they’re submitting fewer costly health claims.

That tells me that for every body lying on the couch—or lying, uh, from the couch—there are considerably more dutifully fulfilling the demands of the program. Call me a cynic…but what is wrong with these people?

I called Dr. Ron Goetzel, the Emory University researcher and nation’s foremost expert on the psychology of these health programs, to find out. At the most basic level are folks learning how to live healthily for the first time. Then there are those who know better and will make healthy choices if they’re surrounded by a supportive community encouraged to make healthy choices, too. (As any member of Weight Watchers or AA will tell you, community is a major part of their success. People whose colleagues go walking at lunch make healthier choices than those whose colleagues waddle down to the greasy spoon.)

And people whose employer not only sanctions those long exercise lunches—but expects them? These folks make the healthiest choices of all. Workplace programs wield subtle psychological heft—particularly ones, like King County’s, that use the carrot of free incentives instead of the stick of punitive charges for unhealthy behavior. “Some employers weigh their employees, screen for smoking, that kind of thing,” Goetzel told me. “But that’s cumbersome and expensive. And based on distrust. Sure, King County could do a health audit on its employees. Instead it’s going out of its way to provide healthy incentives for free. Why would you take advantage of that?”


So the trust that makes the program so easy to cheat is the very thing that makes it such a powerful motivator. Could even be the wave of the future in the health care business—if one can judge by the numbers of private and public employers looking to King County as a model. Which now stands at 200, and counting.

Me, I’m just looking at Ron Sims. Once he got his dismal health assessment he owned up and assumed the stature of a leader who would not ask his team to do a thing he wasn’t himself willing to do. That’s when he launched a full-on fitness regimen, began biking to work, and dropped 50 pounds. I suppose it would be peevish to mention that a few years later he also left King County. Poor guy probably just wanted a doughnut.

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