There's been a lot of attention given to the Indianapolis group that is going to be docking its employees' paychecks for unhealthy "behaviors" like being fat or having high cholesterol. Some thoughts -
First, obviously those aren't behaviors. Duh. And our bodies are just not completely under our control. Weight and cholesterol both have very high heritability (up to 80% by some estimates). Many factors influence our health status, and overemphasizing personal responsibility just leads to victim blaming. I know such policies are supposed to help with insurance costs, but what's next? Dock the pay of all people with diabetes? How about cancer? And why stop at things with a small bit of behavioral influence? Why not dock those with sickle-cell? Cerebral palsy?
Second, there's a larger issue here. For quite some time, workplaces have been implementing "wellness" programs that reward people (with money or other incentives) for engaging in certain behaviors such as getting a flu shot or joining a gym. Many people think that is fine, since it is not a punishment system. What they fail to realize, however, is that withholding a desirable stimulus is punishment. (In behaviorist terms, it is "negative punishment.") Reward and punishment are just two sides of the same coin, so not receiving the yearly incentive because one did not get a flu shot this year is PUNISHMENT for not getting a flu shot.
And a third issue. The whole "workplace wellness promotion" system implies that a behavior is either healthy or unhealthy, good or bad, desirable or undesirable for all people in all places at all times. In reality, our health choices are more complex than that. For me, not going to the gym was a health enhancing behavior this past year, because the gym had too much of a weight-loss emphasis. But in a wellness promotion program, I would not be rewarded for that choice. In fact, I would be punished, because I would lose the reward. Same with flu shots. Flu shots have pros and cons. They are not just plain healthy. They are an option for people to choose with as much accurate information as they can get and without the coercion of their employer. Pretending that some behaviors are 100% healthy makes an already health-ignorant population all the more health-ignorant. It seems so harmless, though, rewarding people for engaging in healthy behaviors. But what about the women - usually poor minorities - who have been paid to be sterilized in the past? It was a "public health program" promoting "healthy behavior" for "their own good," right? But it was wrong. Nobody can make a free choice about health behavior when they know that one choice will lead to reward and the other to punishment.