A reader proposes a nudge to create a routine now. You’ll thank him later.

Reader Travis Walker says he is contributing more to his 401(k) thanks to Nudge – and he didn’t even need a default rule! Recognizing the power of routines in daily lives, Walker sends along a proposal for a structured plan to help “procrastinators” take care of routine check-ups or maintenance on their bodies, their cars, or their homes. He specifically sketches out the idea as it would pertain to health, calling it the Health Care Agreement Account (HCA).

The Health Care Agreement Account

Purpose: Help procrastinators to create an incentive to get periodic checkups, auto maintenance repairs, teeth cleanings, eye exams, etc (basically any routine exercise that the everyday person intends to do but often does not).

Process: Pay an up front amount—say $500—on January first to your doctor/private insurance company (or auto service company) that is remitted to you as you complete your various annual checkups (auto maintenance appointments) by predetermined dates. If you do not complete your end of the agreement (getting your checkup) then the up front payment you made is kept by your doctor/private insurance company.

Hypothetically: I agree on January first to give you—my doctor—$500 which you will then give back to me when I get my cholesterol checked by March first and a colonoscopy by July first. I will get $200 after my cholesterol is checked and $300 (plus possibly a dollar or two more depending on interest) back after my colonoscopy exam. If I do not do these two things than I am not remitted my $500 and I have learned a valuable lesson.

Such an approach to routine medical check-ups (and car maintenance) would provide people with the incentive to go to the doctor on time, get their oil checked regularly, get their teeth cleaned regularly, etc. Also, as more and more people start to get their checkups (as opposed to skipping them) the costs of providing them will go down—maybe such routine experiences can be administered at Wal-Mart while doctors and nurses stick to the more pervasive measures.

The best time to encourage a patient to enter into one of these HCA’s is after they have just had a check up (and maybe their cholesterol is a little high) or after they have just came in for a routine oil change only to discover that their water pump now needs replaced—or as Dan Ariely puts it: Wait until they’re in a “cold rational state.”


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