If you want to see what business people look like when they hammer their own thumbs, just talk to them about employee health insurance costs. Their eyes bug out, veins bulge on their temples, and then they really get ticked off. Beyond mad, however, they are flat-out desperate to control the costs of the health care they buy for their employees.

As a result, some employers are now talking about ways to control those costs that would have been the stuff of fantasy even a few years ago. These range from sending employees to places such as Thailand or India for expensive surgeries, to some of America’s major employers now supporting the concept of a government health insurance plan for all Americans. The latter is a change of direction so uncharacteristic that pigs must be flying somewhere.

Among the most important changes in employer direction, however, is their entry directly into the business of improving the health of their employees. For some companies, this amounts to simple measures such as taking soda machines out of the employee break room. Others, however, are on this idea like linebackers on a fumble, with work site wellness councils, health coaches, employee fitness breaks, banning smoking on the work site, and much more.

Scotts Miracle-Gro Co., the big lawn-care product manufacturer, has initiated a drive to cut the rate of rise in its health insurance costs for employees by actively pressuring employees to take better care of themselves on and off the job. Theirs is perhaps the most aggressive work site wellness initiative of any large American company, one that other companies will surely model if Scott is successful.

Among other things, Scott fired a probationary employee because he would not quit smoking, and is being sued by him as a result. Its CEO personally encourages individual employees to lose weight as he walks their production line. Scott built an employee fitness center complete with a pharmacy and doctor’s office across from its main plant.

An outside company Scott hired to manage its employee health promotion program asks Scott employees to fill out lengthy health status questionnaires that help identify those at greatest risk for worsening health and higher health care costs. Health coaches then push higher risk employees to improve weight, exercise more, get cholesterol and blood sugar under control, and comply with their medication plans. Employees who refuse to fill out the questionnaires or work with the coaches on their personal health plans pay up to $1,200 more annually for their health insurance.

What makes this a battle worth fighting for Scott and other companies? Money first and foremost; Scott estimates that every dollar invested in so-called “employee wellness programs” will ultimately save them about $3 in health care costs.

The employer as our harpy for better health, however, raises troublesome questions about how far an employer can and should go in its efforts to hold down health care costs by holding employees accountable for their health. Scott’s fired-smoker legal case is a perfect example of this; what right does Scott have to involve itself in an employee’s personal decision to smoke? On the other hand, what right does an employee have to spend more of Scott’s money on his cigarette-damaged health than it would have if he did not smoke? How far can an employer go in telling an employee to change behavior in order to decrease his or her risk of spending a lot of the employer’s money on unnecessary illness? No one knows, which is why the American business community is watching Scott’s court case to see if Scott will sink or swim in the deep end of this new pool.

Americans adults spend about a quarter of their lives at work, and the workplace has a profound influence on American society. Run appropriately, workplace wellness initiatives could be a powerful force for improved health in the work force. Benefits might include improved population health, a reduced rate of health care cost increases, preservation of employer-based health insurance, and more competitive American businesses. Run amok, however, workplace wellness initiatives could be prying, coercive intrusions into the deeply personal realm of our individual health. It’s also possible that health status could have too much influence on success or failure in the workplace.

Given this risk, and the personal nature of health and health care, some would argue that we should avoid any such role for the employer. We do not have that luxury, however, as employers see ours as a desperate time calling for desperate measures. They are either going to get their health insurance cost increases under control before those increases eat their economic futures or they are going to stop providing health insurance for their workers. Employees are either going to work with their employers to help cut health care costs, in part by getting healthier, or bear all of those costs themselves when employers stop insuring them.

It’s hard to argue with employers who feel this way, given the current lack of any other cohesive, effective social force – such as the federal government – for motivating a large segment of the American population to get healthier. If business does not drive our improved health, who will? Certainly we as individuals are not doing it on our own.

American business in the business of pushing employees to get healthier could be a slippery slope, will involve mistakes, and some of its measures to drive better employee health will go way over the top. Anyone with a better idea for controlling business health care costs than this, or moving more costs to employees, that is likely to work in the next five years should speak up now.

Right, I don’t have one either.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.