You know the clichés about death and taxes. How about wellness and taxes?

Robert Pear of the New York Times reports that Senate Finance Committee chair Max Baucus (D-MT) and Senate HELP committee member Tom Harkin (D-IA) (a long-time champion of wellness and prevention) want to use tax credits or other incentives to encourage workers to live healthier lives.  

There's a growing bipartisan sentiment that our health care system must do a better job at prevention and wellness. Many of our health care problems arise from such factors as tobacco use, obesity, nutrition and lack of exercise. A health care system that addresses these problems—before they make us sick—keeps us healthier and saves money both in health care bills and lost productivity. The challenge for lawmakers is coming up with a way of promoting these goals without having employers or insurers discriminate against people on the basis of their health or medical history (including their psychological history—depression screening can be a component of workplace wellness).

The Times article told us that the ethics experts over at the National Institutes of Health have been thinking precisely about this. The answer, as Steven D. Pearson and Sarah R. Lieber write in Health Affairs, is that co-workers end up footing part of the bill when some people's unhealthy behavior drives up costs.

"The core ethical justification for penalty programs is that employees should be held responsible for voluntary actions that cause harm to others," they write. But, they add, employees should be exempt from penalties when it is "unreasonably difficult or medically inadvisable" for them to meet a particular goal or standard.

Lawmakers are looking at the tax code (as well as changes in insurance and labor laws) because employers provide insurance to most non-elderly Americans and can therefore influence workers to adopt healthier lifestyles. Under current law, they can't give incentives worth more than 20 percent of the cost of coverage. Expanding that is one policy option.

Helen Darling of the National Business Group on Health, a coalition of the largest employers in the country, suggested giving tax breaks to individuals receiving wellness benefits. Whether that will resonate in Congress is unclear; some lawmakers are talking about limiting the employer tax exclusion to pay for expanded health insurance coverage.   

Currently, there is no single, clear federal standard for employer-based prevention and wellness incentives. Employers and insurers are governed now by what Pear calls a "web of federal rules," while the federal government hasn't set standards for what constitutes acceptable wellness and prevention. Look for comprehensive health reform to provide new wellness incentives and to clarify just what those incentives should look like.