One econ major, three (or more) opinions.

It seems as if a lot of the current health system change jargon has to do with getting someone else to whitewash that darn picket fence.

Tom Sawyer, of course, made whitewashing picket fences famous by persuading all of the other boys in town that whitewashing a picket fence is one of the most enjoyable activities around.

Health insurers seem to be inclined to try to get doctors and hospitals to think that making sure that patients get their exercise and their shots, and not too much medical care, is an equally wonderful, profitable activity.

We hear a fair amount about “patient-centered medical homes” and “accountable care organizations” (ACOs) these days. It seems as if “running a patient-centered medical home” and “running ACOs” are the modern equivalent of saying, “Hey, Huck, wouldn’t just love to have the privilege of getting Jane Doe to come in this summer for her mammogram?”

The picket fence concept came to mind today as I was listening to the playback of the third-quarter earnings call for Healthways Inc. (Nasdaq:HWAY).

For investors, the big news is that the wellness and condition management company is reporting $5 million in net income for the latest quarter on $167 million in revenue, compared with $9.5 million in net income on $176 million in revenue for the third quarter of 2011.

Cigna Corp. broke up with Healthways a few quarters back after buying a health management company of its own, and one of the tasks on Healthways’ to-do list is reassuring investors that, yes, there are plenty of other health management customers around, thank you.

But another interesting theme is that another large health plan customer broke up with Healthways because of “risk-shifting to their provider network.”

In other words: the health plan no longer has to worry as much about the condition management risk, because the providers are getting a chance to earn extra cash in exchange for the privilege of handling the condition management risk themselves.

Healthways executives said during the call that one thing they are doing is relying less on care coaches in call centers and more on health management counselors “embedded in the health care delivery system.”

On the one hand: When insurers outsource wellness and condition management programs to doctors, it seems as if that’s a great way to get a complicated, tedious, potentially controversial hot potato of nagging out of the Big Nasty Health Insurer Cootie Zone and the Bright Shiny St. Marcus Welby, MD, Halo.

On the other hand: Maybe Tom Sawyer actually outsmarted himself a bit and would have gotten something – stronger muscles, a longer attention span, a better character – if he’d whitewashed the picket fence himself. Maybe health insurers would benefit from working harder to hang onto the wellness and condition management piece of health care. Maybe, for example, that kind of activity is a good source of steady fee revenue when regulation is causing problems for health insurance premium revenue.

On the third hand: Until Election Day – and until, really, every last possible health-related court case has made its way through the U.S. Supreme Court a few hundred years from – it seems impossible to know whether it makes sense to whitewash the picket fence yourself, get someone else to do it, or just run for cover and let the picket fence worry about itself.