In a cover story in TIME magazine, an interesting if dubious list of “Ten Ideas that Are Changing the World” was described. Included were predictions such as “#8 “The New Austerity” – People will start living within their means”; #4 “Reverse Radicalism” – Talking to retired terrorists will show us how to end terrorism” and #3 “The End of Customer Service” – Sales clerks are being replaced by technology. But of particular interest to readers of this blog might be #9 “Mandatory Health” – Companies are going to make employees lead healthy lives. [D. Wolfe “10 Ideas That Are Really Changing the World” Ageless Marketing Mar 19, 2008]

There are clear indications that some employers, at least, are pushing the idea of a “consumer-based solution” to their already unaffordable and ceaselessly burgeoning healthcare costs. As most already realize, employee health status and behaviors create costs or lost productivity and performance that can be two to five times as much as their impact on healthcare costs, already unbearable. And many favor a common “management” solution to this problem: make healthy behavior and status a requirement, i.e. a condition of employment.

I still recall the time a hospital system CEO for whom I worked at the time included among “company policies” a statement that we expected employees to be loyal to the organization in everything they did. My suggestion that we reword the statement to read that it was our intention to earn employee loyalty, rather than expect it, fell on deaf ears. This was, to me, a position reflecting the attitude of employers during the Depression, when employers felt that they deserved loyalty of their employees for the “favor” of granting them a livelihood, rather than modern realities that employees are valuable, usually essential assets, that need to be attracted, developed, and retained in much the same way that we “manage” our customer assets.

It is understandable, if unfortunate, that it is probably natural that managers who make decisions about employee health feel that managing it is the best strategy, compared, say to marketing it. Many managers still aim to manage customers, for example, and “customer management” technologies, strategies, white papers, and methods continue to sell well, though how well they work is open to question.

But employee health, being something that, in most cases, is “co-managed” when it is managed at all, by employees (dependents and retirees, where applicable) and their chosen health advisers and counselors, with employers well behind in relative influence. Health behaviors, risks conditions, existing acute and chronic diseases and injuries require 24-hour, or at least every-waking-hour attention by employees, and frequent attention by health professionals, while in reality, employers can do relatively little,

Moreover, while employers can enable, encourage, and empower employees, and to far less extent dependents and retirees, via incentives and support devices that may add to their motivation, capabilities and awareness of healthier behavior options, they cannot truly manage such behaviors. When employers have attempted to require a few behaviors as a condition of employment, such as abstinence from tobacco, abuse of alcohol or illicit drugs, they have had limited success, given the difficulties of authenticating compliance with such requirements, to say nothing of federal and state laws plus union agreements limiting such requirements.

Moreover, when they employers restrict their employee hiring to prospects who are already healthy or healthy behaviors, they risk both violation of ERISA, ADA and HIPAA regulations, but missing out on increasingly valuable and scarce talent. One employer might get away with such a strategy, but the fallacy of composition would soon catch up to all if all attempted it. The bright side, of course, is that through employee health empowerment, development, or similar employee-benefit-focused philosophies and interventions, employers have already shown that dramatic savings can be gained with enabling employees to maintain healthy behaviors, reform unhealthy ones, and self-manage their own chronic conditions.

Many employees may be motivated to improve their health, risk behaviors and conditions, and self-management of their chronic conditions. Employer support and recognition of self-motivated efforts need cost little, compared to incentives and rewards (“bribes”) for doing the same. Employees may adopt the “betting” approach to their own health goals, putting up their own money as a self-imposed penalty they agree to pay, but only if they fail to reach goals they set for themselves in an agreed-upon time frame. Such an approach takes advantage of the tendency for people to work harder to avoid losing money than they will to gain some. [R. McKenzie “Dieting for Dollars” Wall Street Journal, Jan 4, 2008.

Any approach to employee health that creates an adversarial relationship between employer and employee is almost sure to end up costing more than it is worth, in one way or another. Taking a partnership approach, such as by investing in worksite support, work environment modification, and ensuring that executives and managers model healthy behaviors and enthusiastic, visible participation in health initiatives, has almost always proven far more effective. Empowerment, per se, delivers the added benefit to employees of enhancing their personal control over their lives and autonomy with respect to their employer. Such added benefit may, by itself, help employers retain the talent they need to survive and succeed, while increasing their productivity and performance at the same time.