Often enough in the late '00s and early '10s, I would be in meetings with consultants and employers, talking about how our well-being program could not only help employees improve their health - and maybe save some money on health plan costs - but that it could also help reinforce a culture that valued their people. It seemed natural to believe that strong cultures would help with both attracting and retaining high-quality talent.

But this past January, I noticed that Business Insider was describing how work and business cultures have become "sink-or-swim" environments. Perks reduced, work-in-the-office mandates back, layoffs continuing even as profits hold. An HR practitioner who once brought in yoga instructors and meditation teachers to help her company's people manage burnout said she's not doing that anymore. Attracting and retaining talent, she said, is simply not as high a priority as the common wisdom has tended to hold.

Getting further from shore
The deeper currents point to a continuing deterioration in how companies seem actually to care about their people. Not that that's a "new thing." But when I got into the well-being business in the early '00s, most companies I encountered embraced the idea of a wellness program as "Wonderful! We love this idea! We view our people as family, and we want them to be healthy, happy, present and productive!"

And, every so often, I'd encounter one where the CEO said the opposite: "I love this idea! My people take advantage of me at every turn. They malinger, they make up excuses, and they're costing me a fortune on my health plan! Finally, something that can help me force them to pay more attention to their health!" Needless to say, I told him I didn't think a wellness program was actually a good fit.

The Atlantic ran a long piece in February about what AI will do to jobs. They weren't really "forecasting" anything because, in general, economists can't agree on whether anything has actually happened yet.

But there was - to me - a startling number about the perception people have of the longer-term impacts:

71% of Americans told Ipsos / Reuters they're worried that AI will put too many people out of work permanently.

And they note that quit rates have fallen below pre-pandemic norms. And nearly two-thirds of CEOs surveyed by Yale plan to hold headcount flat or reduce it this year. Mercer shows a somewhat compounding dynamic: health plan cost increases alongside dramatically lower employment growth forecasts.

Engaging from fear?

I suppose some people will "engage" with their employer - and with their employer's benefit programs - because they're afraid of what might happen if they don't. But is that authentic "engagement?" Or is it performative "avoidance" of a harsher choice?

An anxious employee and a secure employee use benefits differently. The anxious one does not call the navigation vendor. And they likely don't really care about the EAP. I mean, how is the EAP going to help me cover this month's rent?

And what about condition management programs? Does raising a hand for help look like disclosing a problem, and disclosing a problem looks like volunteering for a blacklist?

We have spent years treating non-participation as a communication failure. Some of it is - I've heard that song many times. But some of it is now a rational risk calculation made by someone who has read the room correctly.

And there's no utilization report that can distinguish between the employee who's afraid - over bills, health, family - and the one whose attention has simply not been captured. Two people; decidedly different situations and world views and beliefs. Why would we ever think they'd respond to the same perfunctory outreach message?

The deep end that most stop/loss reports don't cover
Then there is what waits for the people who do swim toward care.

The New Republic reported this year that roughly 488 U.S. hospitals are private-equity owned, more than 22 percent of all for-profit hospitals, and that PE-controlled physician practices grew from 816 in 2012 to 5,779 in 2021.

The outcomes research is not ambiguous. And it is not a story about one bad system in one bad region — the findings below are facility-level, drawn from national samples matched against comparable hospitals and nursing homes.

Employers are paying 6.7 percent more this year to point people toward that system, up from 4.5 percent in 2024. Average pay increases are forecast flat. The thing we are buying is getting harder to vouch for.

As the one writing this, and for most of those reading this: we are extraordinarily fortunate. You don't persist in the benefits business if you're not making pretty good money - it's just too hard / stressful.

But for far too many of the employees we serve through the employers we contract with, sink-or-swim is a fair description of the labor market. And it's a lousy operating philosophy for a benefits program, because it assumes swimming well is something people already know how to do.

Too often our response is, "Hey, check out our awesome new portal!"

The last question
So the question I am sitting with: what would it actually look like to design benefit program engagement for a workforce that is afraid — rather than for one that we want to believe is actually making discerning choices?

~ Mark Head
© 2026. All Rights Reserved.

Aspirations
“Most of them are unaware that this is about to happen. It sounds crazy, and people just don’t believe it.”

~ Dario Amodei, CEO of Anthropic, on white-collar job displacement, May 2025

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