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A public option isn't the only hot healthcare issue

Personal options in any federal support of 'wellness' programs need to be wider.

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The public option should not be the only hot issue in the healthcare debate.

Before Congress acts, it needs to widen the personal options in any federal support of "wellness" programs.

Preventive care, such as company plans that help employees become healthy or stay healthy, may not be as simple an idea as lawmakers hope. Yes, an ounce of prevention is worth a pound of cure – as well as billions in savings – assuming more people adopt a better quality of life.

But a bill that aims to inject a government hand into personal health decisions should not slide easily into law without a larger discussion over who decides the various ways to wellness.

One Senate proposal, for example, would spend up to $10 billion a year to promote healthy lifestyles – building bike paths, for example, or encouraging farmers' markets – based on the idea that often a change in one's personal behavior is the best way to avoid illness.

It would also spend $1 billion over five years in support of wellness programs at companies with fewer than 100 workers. Already, many big companies save money on insurance costs by rewarding workers with hefty discounts on their premiums if they lose weight, kick smoking, or meet certain medical criteria. The bill would also try to prevent an employer or insurance company from imposing conditions that are "overly burdensome" or might reduce coverage of workers who don't fit a company's profile of wellness.

Preventing discrimination based on a person's health, however, is only one issue.

Another one involves workers who prefer privacy and don't want to reveal health information. Should they be forced to pay more for insurance? And could a company that mandates health tests for insurance purposes be in violation of the Americans with Disabilities Act?

But a more important discrimination issue may be this: How much should government-backed wellness programs define the methods of achieving and keeping health?

During the presidential campaign, Barack Obama was asked if he would support alternative methods of healing. He replied that government "should do what works." And in a speech to the American Medical Association, he asked Americans to take "more responsibility for our health and the health of our children."

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