When you attend a conference about consumer-driven health care (in my case, the CDHC Solutions Forum in Denver this week), you're obviously going to hear a lot of praise for wellness programs.

Simply said, employers like the idea because they can pass off some responsibility to their employees while saving money on medical expenses. Then of course, there's the idea that health care reform will diminish good ol' fashioned employer-sponsored health plans—and consumer-driven care might be some of the only health care employees will get from their company.

But during one of the last panels on Friday, someone broke out with this query: "Well, it all sounds great, but do people really have the discipline?"

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Good question.

And the guy who asked this had an interesting little anecdote to go with it. Last night, he's leaving the conference and sees a nice looking couple sitting in their nice, luxury car. They get out and have a cigarette. The three of them strike up a conversation and the couple says they won't smoke in that nice car of theirs.

So they don't want to damage their leather interior or mess with that new car smell, but they've got no qualms about damaging their bodies (and obviously they've seen enough scary photos and enormous print warning labels on their cigarette packs to know smoking ain't good for you).

Just how accountable are people for their own well-being? Not very, it looks like.

There's been rumors some employers are resorting to not hiring smokers or not offering benefits unless employees pass a physical exam. (But on a similar note, many companies and institutions claim to offer drug testing, but most don't. So do we really think next HR folks will be searching for a pack of Camel Lights in a potential employee's glove box, or will make them get tested for expensive BMI tests? And if they do, you think employees, or potential employees, will think to themselves, "It's really nice they're doing this for me. I really want to work here"?)

As one panelist pointed out (which applies to many things, really): You'll never get commitment if you shove it down someone's throat.

Employers and the government and consumer magazines can talk about the benefits of taking care of yourself all they want, but if a person doesn't care to change, they won't. Threats and ultimatums don't tend to work, even in the workplace.

People will end up doing want they want in the end—they'll smoke, they'll booze, they'll eat crap all day long and throw caution to the wind simply because they can. The only way the employer can help them is if they really want to help themselves—and maybe offer them cash incentives while doing it. Or maybe a nice, luxury car.

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