As a follow-up to today’s earlier blog post, “Who bears the responsibility for health and the cost of health,” the concept of “wellness” at the employer level—and the issues of fairness and appropriate incentives— is getting a lot of national attention.

Per this article in the Los Angeles Times, this focus began with the approval of the so-called Safeway Amendment as part of President Obama’s healthcare  reform (PPACA, or Patient Protection and Affordable Care Act), which allows employers to provide employees with reimbursement of up to 20% of insurance premiums (rising to 30% in 2014 or 50% with special approval) if they participate in reasonable wellness programs.

According to the National Business Group on Health, which represents large employers including Wendy’s, about 68% of its members either offer a discount of several hundred dollars on health insurance premiums to employees who quit smoking, or provide other incentives or penalties to make it happen. This article in the New York Times explores how a particular group—Teamsters hired by BNSF Railway—is responding to the push to lose weight and increase overall health.

As the LA Times notes, the idea of employee “wellness” raises another important angle in the debate over health care cost containment: lower-wage workers tend to have higher rates of the health problems [we’re] trying to fix: smoking and obesity.

The evidence is mixed on how well incentives work, but large employers are already embracing them to encourage good diets and exercise—with an eye toward keeping their employees from missing work and to keep health costs down.

The situation brings together many different aspects of health care issues, including how to promote good health, how “good health” is measured from an employer (and insurance risk) standpoint, socioeconomic differences in good health and lifestyle, and whose responsibility it is to encourage the workforce in general to adopt a healthier lifestyle, or bear the cost of maintaining lifestyles which statistically are shown to lead to long-term—expensive—health problems.