Would getting America in shape help pay for health care reform?

Tax on Health Benefits Weighed, in today's Washington Post, says taxing employer health care benefits whose value is above a certain benchmark is in the offing as a way to help offset "nearly $420 billion over the next 10 years — a sizable chunk of the $1 trillion or more likely to be needed to expand [health care] coverage for the uninsured."

$420 billion over 10 years comes to $42 billion a year. According to Brian J. Sharkey and Steven E. Gaskill's Fitness and Health, Americans are individually and collectively paying a high price for being inactive, sedentary, and generally out of shape. The book says:

Activity can reduce heart disease and control heart disease risk factors — elevated cholesterol, high blood pressure, diabetes, and obesity. Inactivity contributes to a substantial number of deaths annually and costs $94 billion a year in medical expenses in the United States" (p. 3).

If we could convince just half of out-of-shape Americans to adopt an active lifestyle, we'd save $47 billion annually in medical costs — $5 billion more than Congress is now pondering extracting from our wallets in extra taxes.

Let's pay Americans to get, and stay, in shape!

There would, first of all, have to be some measurable parameters of activity and fitness that, if achieved, would result in Americans' getting money back from Uncle Sam. Being neither overweight nor obese — nor underweight — would qualify here. For those who are presently too heavy or too skinny, attaining a normal weight would bring in dollars. For those whose weight is presently OK, staying that way would bring cash rewards.

Other possible parameters that could be monetized include: being able to pass the various components of standard physical fitness tests; having a desirable resting heart rate; having a desirable ratio of "good" cholesterol to "bad"; having a desirable ratio of waist girth to chest girth; and so on.

Not only would measurable parameters earn cash, so would desirable behaviors. Visiting the gym. Taking one's prescription medications faithfully. Getting checkups.

We'd need scorekeepers: doctors, personal trainers, gyms, athletic clubs, anyone who could certify our good or improved behaviors.

We'd need a way to deliver the cash. Tax credits would work for those who file income tax returns, but a significant number of lower-income people don't, so there would have to be a way to pay them for healthy lifestyles. Perhaps they could be issued debit cards which Uncle Sam would stock with money in exchange for fitness.

I'm serious about this! Why do what President Obama vowed not to do when he was on the campaign trail last year? Why tax employer health care benefits, which have historically never been taxable? Why not pay citizens to sidestep risks of bad health and high medical expenses, simply by getting adequate regular exercise?