The Senate devoted long sections of its 2,074-page health care reform bill to promoting wellness, both in the Medicare and Medicaid populations and among the privately insured. The bill establishes demonstration wellness projects in government programs and asks all insurers to report on what they do to promote better health.

And, in what at first blush looks like a bold use of economic incentives, the bill permits employer-based insurance plans to award premium discounts of up to 30 percent to plan beneficiaries who participate in smoking cessation, stress management, physical fitness, nutrition, weight management, and heart disease and diabetes prevention programs as long as the programs are "not unreasonably burdensome (and) are not a subterfuge for discriminating based on a health status factor." Current Labor Department regulations limit the incentives to 20 percent of plan costs.

Promoting wellness makes sense. An estimated 20 percent of Americans suffer from chronic conditions like heart disease and diabetes that arise from being out-of-shape and overweight. Chronic disease now account for 75 percent of all health care costs.. Nearly half of all cancers are related to smoking and obesity. Reducing chronic disease and adopting significant cancer prevention strategies (as opposed to screening, which is early detection) are key to any strategy that hopes to hold down the rate of growth in the nation's $2.4 trillion health care tab.

But do private insurers, which will add tens of millions of new customers to their 170 million-person base through the new subsidies in the bill, have the know-how that will convince employees and their families to participate in wellness programs? Will financial incentives like those allowed by the Senate bill encourage greater use? And, most importantly of all, will employer-based wellness programs actually succeed in reducing health care costs?