Those who can't get vaccinated for medical or religious reasons will be asked to wear a mask, said Jonathan Perlin, president of clinical services and chief medical officer for the Nashville-based HCA, which has nine hospitals and 12,000 employees in the Houston area. For those who won't, he said, HCA will consider that as a resignation.

To avoid conflicts by asking hospitals to fund the center, Chassin created an endowment with $10 million from the group’s own reserves and raised additional donations from the American Hospital Association, GE Healthcare and Johnson & Johnson, among others. Over five years, he says, its aim is to raise a total of $100 million. The Commission will offer materials developed by the program online for free, but of course, may benefit from charging hospitals consulting fees to figure out how to use them.

By wearing a GoZone pedometer and tracking daily activity, employees will accumulate points (HealthMiles) toward a reward based on their levels of activity. Moderate activity pays off -- walking, playing with the kids, cycling. Participation is optional and requires employees to make a $2.50 contribution each payday, which is every two weeks, to the cost of the program.

And while the nation has long been bracing for a surge in Medicare as the boomers start turning 65, the new report makes clear that fat, not just age, will fuel much of those bills. In every state, the rate of obesity is higher among 55- to 64-year-olds – the oldest boomers – than among today's 65-and-beyond.