Skin in the game

I was chatting with a friend who works in the health insurance industry. He maintained that people will only do things if there's financial motivation; however, it's not just any financial motivation that works, but skin-in-the-game financial motivation.

His example: If I paid you $25 each week to get off the couch and go exercise, would you do it? What if instead I took back $25 from your paycheck each week for you to get off the couch and go exercise, would you do it?

He claimed that the first method doesn't work. Paying a person to exercise doesn't motivate. What would that individual do with that newly found money — go shopping? Go out to eat? Donate it? What? Instead, he claimed that the second method is the only thing that does work as motivation, i.e. knowing that money I earned isn't coming to me unless I go do the expectation will be sufficient motivation to make me change behavior.

"I don't like either method," I respond. "Since when do you have the right to hold back part of my salary that I worked hard to earn just to get me to exercise if that expectation isn't what I accepted initially when I hired on? Besides, for the first method, there's something fundamentally wrong if people have to be enticed and lured to engage in healthy behaviors. Shouldn't we all want to be healthy on our own?"

"Yes, we should all want to be healthy. But do we all want that? That's the real question. Look around. How many healthy people do you see?"

"How judgmental can you be," I reply. "I see lots of folks around me who appear to be fit and healthy." "Maybe so," he responds, "but those aren't the folks health insurance companies are worried about."

When skin-in-the-game becomes dangerously flabby, then do we worry?

[Nancy Linenkugel is a Sylvania Franciscan sister and chair of the department of Health Services Administration at Xavier University, Cincinnati Ohio.]