Are you a man with a waist measuring 40 inches or more? If you want to work at Michelin North America Inc., that spare tire could cost you.
你的腰围达到或者超过40英寸了吗？如果你想在米其林北美公司(Michelin North America Inc.)工作，腰部的这些赘肉可能会让你付出代价。
Employees at the tire maker who have high blood pressure or certain size waistlines may have to pay as much as $1, 000 more for health-care coverage starting next year.
从明年开始，这家轮胎制造企业里患有高血压或腰围达到一定尺寸的员工也许不得不额外支付多达1,000美元的医疗保险费用。
As they fight rising health-care costs and poor results from voluntary wellness programs, companies across America are penalizing workers for a range of conditions, including high blood pressure and thick waistlines. They are also demanding that employees share personal-health information, such as body-mass index, weight and blood-sugar level, or face higher premiums or deductibles.
就在应对医保费用不断上升、自愿健康计划收效甚微的局面的同时，全美各地的企业开始对具有某些身体状况的员工实施惩戒措施，其中包括高血压和粗腰围。他们还要求员工提供体质指数、体重和血糖浓度等个人健康信息，否则员工会面临更高的保费或自费额度。
Corporate leaders say they can't lower health-care costs without changing workers' habits, and they cite the findings of behavioral economists showing that people respond more effectively to potential losses, such as penalties, than expected gains, such as rewards. With corporate spending on health care expected to reach an average of $12, 136 per employee this year, according to a study by the consulting firm Towers Watson, penalties may soon be the new norm.
公司领导说如果不改变员工的习惯，他们无法降低医保费用。他们援引了行为经济学家的研究成果，认为相比奖励这样的预期收益，人们对罚金这样的潜在损失会做出更有效的反应。根据韬睿惠悦咨询公司(Towers Watson)的一项研究，由于美国各公司今年在员工医疗保健方面的花费预计会达到人均12,136美元，处以罚金也许很快会成为大势所趋。
Employers may argue that tough-love measures, such as punishing workers who evade health screenings, benefit their staff and lower health-care costs. But such steps also portend a murky future in which a chronic condition, such as hypertension, could cost workers jobs or promotions─or prevent them from being hired in the first place.
老板们也许会说，诸如处罚逃避体检的职员这种严爱式的措施可以使员工受益，并降低医疗保健费用。不过这些措施对员工而言也预示着一个暗淡的前景，像高血压这样的慢性病可能会让员工失去工作或晋升机会──或者一开始就成为了妨碍他们被录用的障碍。
Until recently, Michelin awarded workers automatic $600 credits toward deductibles, along with extra money for completing health-assessment surveys or participating in a nonbinding 'action plan' for wellness. It adopted its stricter policy after its health costs spiked in 2012.
就在不久前，米其林还一直针对自付费用部分向员工提供600美元的自动奖励金，以及用于健康评估调查或参加非约束性健康“行动计划”的额外资金。2012年公司的医疗保健开支大幅上升之后米其林才采取了更为严格的政策。

Now, the company will reward only those workers who meet healthy standards for blood pressure, glucose, cholesterol, triglycerides and waist size─under 35 inches for women and 40 inches for men. Employees who hit baseline requirements in three or more categories will receive up to $1, 000 to reduce their annual deductibles. Those who don't qualify must sign up for a health-coaching program in order to earn a smaller credit.

现在，这家公司只对那些在血压、血糖、胆固醇、甘油三酯和腰围──女士35英寸以下，男士40英寸以下──方面达到健康标准的员工予以奖励。有三项及以上指标符合最低要求的员工会得到最高1,000美元的奖励，这样可以降低他们的年度自付部分的费用。那些达不到要求的人则必须报名参加一个健康指导项目才能得到额度缩小的奖励金。

Employee-rights advocates say the penalties are akin to 'legal discrimination.' While companies are calling them wellness incentives, the penalties are essentially salary cuts by a different name, says Lew Maltby, president of Princeton, N.J.-based National Workrights Institute, a nonprofit advocacy group for employee rights in the workplace. 'No one ever calls a bad thing what it really is, ' he says. 'It means millions of people are getting their pay cut for no legitimate reason.'

员工权益维护人士说这样的惩戒与“法律歧视”没什么区别。卢•莫尔特比(Lew Maltby)是总部位于新泽西州普林斯顿(Princeton)的非盈利在职职工维权组织美国工作权利学会(National Workrights Institute)的主席，他说，虽然企业称之为健康激励机制，但是这些措施实质上是在以不同的名义减薪。他说：“对于坏事情没有人会实话实说。它意味着数以百万计的人在毫无合法理由的情况下被减了薪。”

Companies may say they have tried softer approaches, but many haven't exhausted their options, like putting healthier food in their cafeterias, building a fitness center or subsidizing gym memberships, he adds. 'At best, these programs are giving employers an enormous amount of control over our private lives.'

他还说，企业也许会说他们已经尝试了更柔性的手段，但其实很多企业都还没有倾尽全力，比如在食堂里提供更健康的食品、建立健身中心或者补贴健身房会员费。“这些计划充其量是让老板大大增加了对我们的私生活的控制。”

Michelin denies any discrimination and says the policy is voluntary. Not participating means employees won't get the incentives. Wayne Culbertson, Michelin's chief human resources officer, says the old incentive programs didn't lead to meaningful change. For example, an employee could pledge to start walking daily, he says, but never have to prove it. 'It was sort of free, you know? You got $600 just for being a good employee.'

米其林否认有任何歧视，声称这项政策是自愿的。不参加的员工就不会得到奖励。米其林的首席人力资源长韦恩•卡伯特森(Wayne Culbertson)说，旧的奖励机制并没有带来实际意义的变化。比如，一名职员可以承诺开始每天散步，但从来不用证明自己真的这么做了。“这有点像免费大餐，你知道吗？你当好一名员工就可以得到600美元。”

Six in 10 employers say they plan to impose penalties in the next few years on employees who don't take action to improve their health, according to a recent study of 800 mid- to large-size firms by human-resources consultancy Aon Hewitt. A separate study by the National Business Group on Health and Towers Watson found that the share of employers who plan to impose penalties is likely to double to 36% in 2014.

根据人力资源咨询公司怡安翰威特(Aon Hewitt)最近对800家大中型企业的研究，六成企业的老板说他们计划在今后几年里对不采取行动改善自身健康状况的员工实施惩戒。由美国企业员工健康组织(National Business Group on Health)和韬睿惠悦公司开展的另一项研究发现，到2014年，计划实施惩戒措施的雇主比例很可能会翻番，达到36%。

Current law permits companies to use health-related rewards or penalties as long as the amount doesn't exceed 20% of the cost of the employee's health coverage. John Hancock, a veteran labor and employment attorney at Butzel Long, a Detroit-based law firm, says that while companies can't legally dock a worker's pay for a health issue, they can tie an employee's health-care bill to whether the worker meets or misses health goals. As long as employers offer exemptions for workers with conditions that prevent them from meeting health goals, the firms are in the clear.

当前的法律允许企业实施与健康相关的奖励或处罚手段，只要数额不超过员工医疗保险费的20%。约翰•汉考克(John Hancock)是总部位于底特律的柏隆律师事务所(Butzel Long)一位劳动用工方面的资深律师，他说虽然企业不能因为健康问题合法降低员工的工资，但它们可以把员工的医疗保健账单与员工是否达到健康目标挂钩。只要企业为那些身体状况致其无法达到健康目标的员工提供了免费额度，从法律角度来说就没有任何问题。

The situation is less clear if, for example, a company ends up singling out obese employees by charging them more for health coverage. If the obesity is linked to an underlying condition, the employer may be liable for discrimination, Mr. Hancock says.

假如一家公司最后单单挑出长得胖的员工收取更多的医疗保险费用，情况就不那么明朗了。汉考克说，如果员工的肥胖与身体的基本状况有关系，老板可能就有歧视之嫌。

Currently, most companies tie between 5% and 10% of employee premium costs to incentives, but that will likely go up, says Charlie Smith, chief medical officer for national accounts at insurer Cigna Corp.

信诺保险集团(Cigna Corp)负责国民账户的首席医疗长查理•史密斯(Charlie Smith)说，目前，大多数公司将员工保险费用的5%至10%与奖励机制挂钩，但是这个比例很可能要提高。

Pharmacy chain CVS Caremark sparked outrage among employees and workers-rights advocates last month by asking staff members to report personal health metrics, including their body fat, blood sugar, blood pressure and cholesterol levels, to the company's insurer by May or pay a $600 penalty.

上个月，药品连锁企业CVS Caremark要求员工5月之前向公司的保险承保人报告包括自己的脂肪比率、血糖、血压和胆固醇值在内的个人健康指标，否则将面临600美元的罚金，此事在员工和员工权益维护人士中引起众怒。

Few workers can afford to refuse, but some aren't happy. 'It opens a Pandora's box, ' says a full-time CVS employee who works at a distribution center in Florida. 'It's none of their business.' While the 26-year-old describes himself as healthy, he says he is worried about disclosing health information that could be shared without his knowledge. He says he plans to cancel his health plan, which also covers his wife and child, and will start looking for work elsewhere.

没有几名员工拒绝这项要求，但是一些人很不开心。在佛罗里达一个配送中心工作的一名CVS全职职员说：“这开启了潘多拉的盒子。健康指标与他们毫不相干。”虽然这名26岁的年轻人表示自己很健康，但他说他担心自己的健康信息有可能在自己不知情的情况下被泄露。他说他打算终止自己现有的医保计划（该方案把他妻子和孩子也纳入了保险），然后到别处另找工作。

CVS, which maintains that the change is intended to make workers aware of their health risks, says it doesn't have access to workers' screening results.

CVS坚持认为改变政策的目的是让员工注意自己的健康风险，该公司说它无法获得员工的筛查结果。

Mohawk Industries, a Calhoun, Ga.-based flooring company, says participation in its company's health-risk assessment process shot up to 97% after the company imposed a $100 monthly penalty on nonparticipants. The company had previously offered rewards for participating in the assessment, but enrollment rates were low, says Phil Brown, senior vice president of human resources.

总部设在佐治亚州卡尔霍恩(Calhoun)的地面材料生产商莫霍克工业公司(Mohawk Industries)说，公司对不参加健康风险评估程序的员工硬性实施每月100美元的罚金之后，参加者的人数飙升至97%。该公司负责人力资源的高级副总裁菲尔•布朗(Phil Brown)说，公司以前对参加评估的人提供奖励，但是报名率很低。

Honeywell International Inc. recently introduced a $1, 000 penalty─deducted from health-savings accounts─for workers who elect to get certain procedures such as knee and hip replacement and back surgery without seeking more input. The company had offered $500 for participating in a program that provides access to data and additional opinions for workers considering surgery, but less than 20% of the staff joined up. Since it flipped the incentive to a penalty, the company says, enrollment has been above 90%.

霍尼韦尔国际公司(Honeywell International Inc.)最近出台了对未寻求更多健康投入就选择接受膝关节和髋关节更换以及背部手术等疗法的员工处以1,000美元罚金的政策──从医保储蓄账户中扣除。该公司过去曾为员工提供500美元的资金，让考虑做手术的员工参加一个可以提供相关资料和其他意见的项目，但是不到20%的员工参加了那个项目。自从公司将鼓励的政策变成处罚之后，该公司称，报名该项目的人数超过了90%。

There are no new data on surgeries, but the change is projected to save at least $3 million annually, says Brian Marcotte, Honeywell's vice president of compensation and benefits, who presented the plan at the Conference Board's Employee Health Care Conference last month.

霍尼韦尔公司负责薪资与福利的副总裁布赖恩•马科特(Brian Marcotte)说，目前还没有关于手术的新数据，但是政策的改变预计每年可以节省至少300万美元的资金。他上个月在世界大企业联合会(Conference Board)的员工医疗保健会议(Employee Health Care Conference)上提出了这个方案。

Typically, 20% of a company's workforce drives 80% of health-care costs, according to Cigna's Mr. Smith, and roughly 70% of health-care costs are related to chronic conditions brought on by lifestyle choices, such as overeating or sedentary behavior. But when employers target those conditions, employees themselves may feel targeted, especially when it comes to their weight. While companies can't say it outright, many of their measures─such as high cholesterol and high blood pressure─are proxies for obesity.

信诺保险集团的史密斯称，一家企业里往往是20%的员工动用了80%的医疗费用，而大约70%的医疗费用都跟生活方式所引起的慢性疾病有关，比如过量饮食或久坐行为。但是当雇主针对这些情况采取措施时，员工可能感觉到自己成为了被针对的对象，尤其是涉及到他们的体重时。虽然公司不能明示，但是它们的很多衡量尺度──比如高胆固醇和高血压──在肥胖者中都是非常普遍的。

A 2011 Gallup survey estimated obese or overweight full-time U.S. workers miss an additional 450 million days of work each year, compared with healthy workers, resulting in more than $153 billion in lost productivity.

2011年的一项盖洛普(Gallup)调查估计，与健康的职工相比，美国肥胖或体重过重的全职职工每年额外误工的天数达到了4.5亿个工作日，造成的生产力损失超过了1,530亿美元。