Unhealthy workers may have to present a doctor’s note to show that they can’t possibly meet the targets even by participating, or they may have to faithfully participate every week—an onerous requirement for some. At the same time, healthy workers check in once a year, meet the targets, and are golden. There may be no requirement for them to exercise or otherwise maintain good health behavior. As one regulator told me: If employers want an exercise program, why not make it available for everyone?

The media have been MIA on the wellness incentive story—the exception being The Washington Post. In a fine story last fall, the paper discussed what it called a “colossal loophole” that wellness incentives could create, and clearly laid out what’s at stake.

The incentives could attack a national epidemic of obesity. They also cut to a philosophical core of the health-care debate. Should health insurance be like auto insurance, in which good drivers earn discounts and reckless ones pay a price, thereby encouraging better habits? Or should it be a safety net in which the young and healthy support the old and sick with the understanding that youth and good health are transitory?

The strongest part of the Post’s story was the anecdotes it presented about the noose tightening around the necks of unhealthy workers. Valeo, an auto parts dealer, raised deductibles from $200 to $2,200 for individual coverage and from $400 to $4,400 for family coverage. Then Valeo told its workers it would reduce the deductible if they quit smoking and met goals for blood pressure, cholesterol, and body mass index. “If they don’t comply, they end up being penalized, if you will, but we refer to it as a Healthy Rewards program,” said director of human resources Robert Wade. If Valeo workers choose not to submit to yearly medical assessments, they get a different coverage with higher premiums.

Other employers talked of the downsides. Jake Flaitz, benefit director for Paychex, a payroll management company, told the Post that “employees could be doing everything right and still not achieve the desired outcome.”

Last month, the Robert Wood Johnson Foundation and the Trust for America’s Health released a public opinion survey showing that 71 percent of Americans favor increasing investments in prevention. “Prevention is clearly one of the most popular parts of health reform,” said Al Quinlan, president of Greenberg Quinlan Rosner Research, which conducted the poll. The question is: Will prevention still be popular when workers find out that their jobs may be on the line, or they have to pay even higher premiums because losing weight is hard?

This all sounds like something that deserves further media exploration, no?

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.