How it will pay to stay fit in Seattle

Participants can score points for healthy behaviors - wearing seat belts, attempting to quit smoking, or wearing motorcycle helmets - and the county will provide online advice and even coaches to help participants take steps toward better health. At each year's end, employees will receive a report card that determines how much they will pay.

In a city that would rather be outdoors, the plan could have broad appeal. Andrea Gray, an elementary school teacher who has just finished jogging around Green Lake with her husband Erik Van Hagen and their black mutt Betty, thinks Seattle is good place to adopt the healthcare initiative.

"All of my friends work out on a regular basis - whether it's yoga, climbing, ultimate Frisbee, or jogging. I think there's sort of a Northwest culture that encourages it."

"I think [the plan] makes sense," adds Mr. Hagen. "Any way you can create incentives to be healthier, it's going to save money."

Even for those less athletically inclined, Caroline Whalen, a deputy administrative officer for the county, points out that those dealing with chronic conditions will not be penalized.

Employees' health doesn't actually have to improve; they just have to make efforts to get healthier. Sims estimates an employee who earned enough points to quality for the gold tier - which confers the lowest costs - could save up to $1,600 a year, and a participating family in the gold tier could save up to $2,400.

Not everyone thinks the plan is equitable. Critics of similar programs feel it's an unnecessary intrusion by employers into the lives of their employees and some feel participants could be tempted to stretch the truth to earn the points.

"It just seems, on its face, unfair to the average county employee," says Tim Miller, an accountant for the county. "I mean, what if somebody lies [on their health assessment form] about exercising? How can you tell?"

Dwight Pelz, a member of the King County Council sees it differently. "It's not, 'If you're a smoker you get penalized.' " he says. It's a little bit of George Bush's idea of personal responsibility. You're encouraged to do a few things to take care of yourself - and if you do you'll save some money. I don't think it's intrusive at all."

Some 92 percent of county employees belong to labor unions, and all but one have signed on to the program, which covers contracts from January 2007 to the end of 2009. The unions realized the plan could preserve jobs and keep insurance coverage from deteriorating.

"Look," Sims says, "If you buy a car, you're limited by your income. If you buy a house, you're limited by your income. But with healthcare, it's as if everyone's been given a credit card with no spending limits and you can buy as much as you want. There's no way to control costs. That's just not a mature approach."

To county employees, he preaches, "Stay fit. Own the decision. Realize there are consequences." He is convinced they will indeed make better choices, and that their prudence will save taxpayers money. "All we need," he concludes, "is to inject the free market into this."

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