Friday, February 1, 2013

Fat Tax Warning

Two related articles appeared in the news last week.  One advised that the Affordable Care Act contained high penalties for smokers.  The second told of a proposal to fight obesity by shaming overweight people.  (That outrageous suggestion demonstrates some people's level of frustration and desperation to solve the problem.)  The relationship between smoking and obesity is hard to ignore.  Both behaviors cause personal health problems and lead to increased healthcare costs.  It seems reasonable to use the history of dealing with smoking to predict future possibilities regarding obesity.

Of course smoking was easier to attack because smokers were a minority and smoking can be irritating to others.  The issue of secondhand smoke affecting the health of children also made it an easy target.  The campaign began with increased cigarette taxes, restrictions on advertising and printed warning labels.  It then moved to legislated bans on smoking in most public places and to policies restricting smoking at work.  States won large legal settlements from tobacco companies, intended to be used for education.  Employers began charging smokers a higher health insurance premium.  It is not uncommon for others to look down on smokers, nagging or trying to shame them into quitting (usually unsuccessfully).  Shaming of smokers is not considered outrageous or objectionable, since we're only trying to help.

In light of that, consider the so-called obesity epidemic.  So far the approach has been comparatively mild.  Sports organizations and doctors encourage kids to get outside and play.  There are health warnings and education about the dangers of being overweight.  Food packaging must post nutritional information, but not yet warnings.  Companies provide opportunities, even facilities, for their employees, and sometimes their families, to work out or be more active.  Since these actions have not made a significant impact, governments stepped in with stricter regulations on school lunches and bans on trans fats.  Last fall New York City passed the controversial ban on large soft drinks.  There has been talk of special taxes on fast food to discourage consumption.  Where may this lead?

Following the smoking model and despite a specific prohibition in the current law, could the next step be health insurance premiums based on body mass index (BMI)?  Could life insurance premiums follow?  Could minors be prohibited from buying certain foods?  Will airlines charge based on the total weight of the luggage and passenger?  These changes may not be out of the question.  I recently read in my local newspaper an expert opinion that it's not fair for healthy people to subsidize the healthcare of those with unhealthy lifestyles.  Further, this CBS News report from two days ago on weight-loss myths concludes with the sentence:  "'The big issues in weight loss are how you change the food environment in order for people to make healthy choices,' such as limiting soda sizes or junk food marketing to children."  Changing the "food environment" sounds eerily similar to steps taken to reduce smoking.

This is a responsibility issue.  We expect to be able to live our lives relatively free of interference, free to make our own choices.  But once we expect the government or our employer to pay our doctor bills, our choices become a "public health issue" and they believe they have the right to tell us how to live.  They become judges of our behavior.  As I have often said, failures in the area of responsibility often lead directly to losses of freedom. A right to free or subsidized healthcare cancels some other rights.  We can’t have it both ways.

Added Note (2/13/2013):  A sugary drinks fee is being considered by the Hawaii Senate as "an important way to fight obesity."

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