I think health insurers, employers and wellness companies need to think harder about how to maximize their ability to improve people’s health and hold down health care costs without provoking a backlash.

Americans smoke too much, eat too much, fight too much and drink too much. Researchers backed by UnitedHealth Group Inc., Minnetonka, Minn. (NYSE:UNH), recently noted in a U.S. health report that 15.5% of U.S. adults say they have engaged in binge drinking in the past 30 days.

Public and private health plans, and employers that sponsor group health plans, should have a say in influencing this kind of behavior, because they pay the majority of the health care bills.

Even uninsured people who pay for as much care as they can out of pocket may end up reaching into insurer, employer and taxpayer wallets when, at some point, they enter the hospital with a serious behavior-related illness.

Filling out a health survey is cheap, easy and doesn’t take much time.

I’m obese and will probably end up high blood pressure, but my parents are still alive and my grandparents all lived long lives, and the only times I’ve ever entered a hospital were for lazy eye surger and to have a baby. I haven’t even had a tonsillectomy, or a broken bone.

On the other hand, when I got a couple of health surveys of my own within the past few months, they really got on my nerves.

My husband is mad at me because he thinks I spend too much time writing about health insurance, so we tried going to a marriage counselor. We have the high-deductible plan with a health savings account, and we paid for the sessions out of pocket. I then got survey that seemed to be written based on the assumption that I was a depressed bulimic ranting in a corner somewhere about the nasty space people who are living in my belly button.

I also have a general-purpose health questionnaire in an e-mail link somewhere.

When I write about the surveys, I generally think, “Oh, great. Surveys.”

When I actually got the surveys, my reaction changed to, “Why are these people who aren’t paying for any of my health care, other than, maybe, a checkup, prying into my affairs?”

Also: if the Patient Protection and Affordable Care Act of 2010 (PPACA) dies, and, even after 2014, health insurers in most states can still use medical underwriting, how can health insurers asking questions about matters that a patient has never cared enough about to bother mentioning to a doctor, then possibly use that low-level health information to deny applications for coverage, or increase the cost of coverage.

On the third hand: I give Google, Yahoo and many Web ad tracking services far more personal data every day than I will ever give to me health insurer.

On the fourth hand: clean sheeting (pretending someone who has risks has no risks) is a crime. I was scandalized a few months back when a federal agency suggested that maybe patients should have a legal right to pay out of pocket for care and ask their in-network doctor not to report the care to the patient’s health insurer.

Thoughts:

  • The risk is pretty high just because every reporter and every high-octane consumer advocate will probably get one of these surveys sooner or later. This isn’t an issue that a reporter has to work to find; this is an issue that hits reporters on the head.
  • The more an entity pays for me care, the more innocuous an questionnaire seems. I’m a lot more inclined to fill out a general wellness questionnaire, because at least my health plan pays for checkups, than to fill out a counseling questionnaire, because my health plan is not going to pay for that.
  • A well-tailored questionnaire might seem less intrusive than an overly general or poorly targeted questionnaire.
  • Maybe, to be effective and not seem oppressive, questionnaire-based wellness programs and care management programs need to run in conjunction with, at least, voluntary insurer agreements about how the answers will be used. If an insurer will increase my rates, say, 10% because I’m fat, well, maybe that makes sense. If an insurer would “reach out to help me with a questionnaire” with one hand, then use information on the questionnaire that wouldn’t normally be in my medical records to make underwriting decisions, it feels as if that would be a little over the top.
  • If insurers will end up keeping the ability to use medical underwriting, and they will get to use information from wellness questionnaires in underwriting, then maybe they should at least come up with a “wellness credit rating” indicator and make sure the plan enrollees know what the rating is, to reduce the sense that the insurers have all the information and the enrollees know nothing.

I don’t really know where the right balance lies, but I think it’s somewhere between the government officially letting doctors keep important secrets from insurers and insurers running programs that, in theory, at least, could lead people to give information about themselves that could lead to huge coverage access problems later on.