Health care and obesity

[Surlethe]

I was thinking recently about a national health insurance plan. In any sort of nationalized scheme, should people who are overweight or obese (save those who are that way because of some rare hormone disorder or other 0.01% of the population) expect to see a single cent for any consequences of their condition other than immediately life-threatening ones? If not, should they expect help for those consequences which are life-threatening, and why? This same logic can be extended to smokers, too.

In some way, this situation seems to be directly analogous to the idiots who are out of homes because they took on stupid mortgages. If they're going to make poor choices, then why should they expect society's support when those choices come back to bite them in the ass, as long as they're not going to die?

Any thoughts?

[Darth Wong]

To the best of my knowledge, none of the major national health plans have such policies in place ... yet. But as the population continues to age, the earning base continues to shrink, and other economic crises start to hit the bottom line, I think we may start to see such policies adopted. But they won't work unless they go all the way, and cut off all care to people who break certain rules.

In some way, this situation seems to be directly analogous to the idiots who are out of homes because they took on stupid mortgages. If they're going to make poor choices, then why should they expect society's support when those choices come back to bite them in the ass, as long as they're not going to die?

The thing is that in the case of mortgages, we can allow "death", ie- foreclosure. In the case of health care, we won't. Even American law requires hospitals to intervene before death. So the real question is: what's the point of denying lesser care, since that only increases the likelihood of the patient ending up in a life-threatening situation where you have no choice but to step in and spend (what may be a greater amount of) money anyway?

[The Duchess of Zeon]

The obvious answer would be to charge obese people and smokers for their medical care.

If you are 5'8" and weigh 300lbs, you get to pay $300.00 for a doctor's visit that someone else would get for free, etc.

[Stark]

Isn't this the sort of thing the tax on tobacco was supposed to do: to both raise the price and cover the social cost of smoking?

Am I going mad or was there a 'fatty food tax' idea floated here, and wasn't popular?

[Darth Wong]

The obvious answer would be to charge obese people and smokers for their medical care.

If you are 5'8" and weigh 300lbs, you get to pay $300.00 for a doctor's visit that someone else would get for free, etc.

It's debatable whether this would really save any money. The most expensive health-care you'll use in your life is when you're in danger of dying, and a lot of people would rather avoid spending the money. Especially poor people. So they'll end up on death's door, and doctors will undertake many heroic (and incredibly expensive) procedures to save them, all at taxpayer expense.

[Darth Wong]

Isn't this the sort of thing the tax on tobacco was supposed to do: to both raise the price and cover the social cost of smoking?

Sort of. But when you tax people at the source, you directly discourage the behaviour. When you tax them at the point of health-care, you discourage them from getting health-care; not the best outcome.

Am I going mad or was there a 'fatty food tax' idea floated here, and wasn't popular?

I recall that as well. I have no problem with a junk food tax, but I'm apparently an arch-commie.

[K. A. Pital]

Healthcare taxes will indeed discourage from healthcare, while punitive food taxes and breaks for those who make healthier foods would discourage junk food consumption. Acting against the core of the problem is the right course of action.

[Darth Wong]

Healthcare taxes will indeed discourage from healthcare, while punitive food taxes and breaks for those who make healthier foods would discourage junk food consumption. Acting against the core of the problem is the right course of action.

Yes, but you're an arch-commie! Remember that in Glorious Capitalist America, we don't believe in solving problems directly if that means we must admit that government is in the business of solving problems. In Glorious Capitalist America, government itself is the problem.

[K. A. Pital]

Given extreme opposition even to taxation to fund healthcare itself, I don't believe anything's gonna change any time soon. So we're kind of discussing a real existing problem, but one that is routinely denied existence by american public opinion.

[Darth Wong]

Given extreme opposition even to taxation to fund healthcare itself, I don't believe anything's gonna change any time soon. So we're kind of discussing a real existing problem, but one that is routinely denied existence by american public opinion.

It's funny how the voters basically write a blank cheque to government for anything that is related to the military, but they think it should subsist on air for everything else it does. It appears that it's OK in America to tax people in order to end lives, but not to save them.

[Illuminatus Primus]

Healthcare taxes will indeed discourage from healthcare, while punitive food taxes and breaks for those who make healthier foods would discourage junk food consumption. Acting against the core of the problem is the right course of action.

Yes, but you're an arch-commie! Remember that in Glorious Capitalist America, we don't believe in solving problems directly if that means we must admit that government is in the business of solving problems. In Glorious Capitalist America, government itself is the problem.

Of course, when presenting possible solutions to obesity issues in an argument with my parents - and included this, I got lambasted as "naive" and "shortsided." Its easy to tax other goods to discourage their consumption, but since we'd have to get the FDA to sit down and draft a proposal, I guess its unthinkable.

I don't know how these anti-government types thought any other problem ever got solved. Not to mention obese lifestyles are obviously a result of the current free market policy; and also the result of "rational actors" making irrational decisions on long term basis. The American lack of a social support system with its appalling commutes and working hours does not help either. But I guess if we are literally eating ourselves dead, I guess all we can do is ask Jesus to help! Just ask Atlanta.

[Androsphinx]

Such things have been proposed in the Uk on a limited scale in the past. Mainly for major things like transplants, etc, but the principle is there with smokers.

[PainRack]

I was thinking recently about a national health insurance plan. In any sort of nationalized scheme, should people who are overweight or obese (save those who are that way because of some rare hormone disorder or other 0.01% of the population) expect to see a single cent for any consequences of their condition other than immediately life-threatening ones? If not, should they expect help for those consequences which are life-threatening, and why? This same logic can be extended to smokers, too.

In some way, this situation seems to be directly analogous to the idiots who are out of homes because they took on stupid mortgages. If they're going to make poor choices, then why should they expect society's support when those choices come back to bite them in the ass, as long as they're not going to die?

Any thoughts?

Ethically, won't that be elitist? Isn't the point of national healthcare to remove barriers against seeking healthcare?

[Covenant]

My healthcare provider offers discounts on prevention, such as Jenny Craig or Curves for Women, or screenings and such, in order to reduce the actual payout required later on down the line. More things like that might be good, but I don't think a tax on junk food is really going to do much more than some of the more mundane regulatory things we do.

It's not all that hard to ban certain things, like MSG or Trans Fats, so unless you're looking to target processed sugars (not a bad thing to tax--you can do it right at the distributor level to make it too expensive to lavish on food items) there's plenty of other ways that you can still attack the problem. The fight's not over, but to actually tax junk food of consequence you'd need to be taxing fast food resturants. But how do you tax something like a burrito? If I drop the sour cream, is it taxed now? Do we tax fry oil? Can we decide to tax regular soda and not diet soda? That'd be fantastic, really. I know I'd love that. So there's a few softball ideas (soft drinks are extremely high calorie things, and most people have no idea) for taxation, but there's some other huge ones too--like getting KFC and others to remove all chicken skins from their product.

People might not know what the fuss is about, but it'd make a big difference for some of these super-high-risk people.

[K. A. Pital]

People might not know what the fuss is about, but it'd make a big difference for some of these super-high-risk people.

We may speak about taxng KFC or at least harmful drinks... however, the consumers of this shit sadly don't give a fuck; accordingly, neither does the American "i'm hands-off anything" government.

[mr friendly guy]

Isn't this the sort of thing the tax on tobacco was supposed to do: to both raise the price and cover the social cost of smoking?

Sort of. But when you tax people at the source, you directly discourage the behaviour. When you tax them at the point of health-care, you discourage them from getting health-care; not the best outcome.

How about taxing them at a later date, like come tax return time? Over here higher income earners are taxed extra - the "medical surcharge" if we don't have private health insurance to help fund the system. Perhaps something like this could be introduce for those describe in the OP who use the public health system.

This way the "I don't have to pay for it now so its ok" mentality will keep sick people actually coming to seek medical help.

[The Duchess of Zeon]

Or, instead of trying taxation, we could just institute Sumptuary Laws which, for example, ban the use of all forms of transfats in all food (as NY has done in restaurants, thank God, etc), ban the use of MSG in all food, and ban the use of corn syrup. That would be a very nice first-step. I'd also suggest making it illegal to buy more than one meat item per shopping trip or at a restaurant (per person, there), rather like the limits on the number of boxes of sudafed you can currently buy. Then you could systematically go through dishes and mandate certain limits on their production. For example, only so much sugar for every 1,000 calories and so on.

The amount of meat Americans consume needs to be ridiculously decreased; I have about one serving of chicken and one serving of beef a week right now. The average American has that every day.

[Illuminatus Primus]

Or, instead of trying taxation, we could just institute Sumptuary Laws which, for example, ban the use of all forms of transfats in all food (as NY has done in restaurants, thank God, etc), ban the use of MSG in all food, and ban the use of corn syrup. That would be a very nice first-step. I'd also suggest making it illegal to buy more than one meat item per shopping trip or at a restaurant (per person, there), rather like the limits on the number of boxes of sudafed you can currently buy. Then you could systematically go through dishes and mandate certain limits on their production. For example, only so much sugar for every 1,000 calories and so on.

This would be difficult to enforce and what is the point if the functional equivalent can be achieved by simply raising the cost of the items to be prohibitive for mass consumption; better yet, those that do buy them pay for the social cost in the system. Why use autocratic bans and other laws like that when you can use economics to your advantage. The only things I could see are bans on transfats and restrictions on HFCS at the supplier level. Institute high taxes and mandatory dietary requirements (think CAFE; for every dish or item produced belonging to a certain poor dietary quality level, two or three other items must be produced at a higher quality level). Then an extra sin tax at the supermarket.

And there's no proof MSG is bad for you.

The amount of meat Americans consume needs to be ridiculously decreased; I have about one serving of chicken and one serving of beef a week right now. The average American has that every day.

People don't buy fillet mignon except sparingly either. We don't have to put Sudafed-limits on it to do that; the cost does it for us. Why BAN things when economics does the work for us and pays for the consequences? Not everything needs to be regulated with the relative sledgehammer of state power, Marina.

[The Duchess of Zeon]

IP, if you start taxing things, you give the government incentive to keep them legal to keep the revenue stream open. They won't want consumption to completely end, because they'll be making money off of the tax.

[aerius]

I'd also suggest making it illegal to buy more than one meat item per shopping trip or at a restaurant (per person, there), rather like the limits on the number of boxes of sudafed you can currently buy.

Looks like I'll be buying a nice big cut of meat every time I go shopping then. Instead of buying a couple steaks, I'll buy an entire striploin and cut it into steaks myself. Or walking out of the supermarket with a whole 15 pound salmon.

[The Duchess of Zeon]

I'd also suggest making it illegal to buy more than one meat item per shopping trip or at a restaurant (per person, there), rather like the limits on the number of boxes of sudafed you can currently buy.

Looks like I'll be buying a nice big cut of meat every time I go shopping then. Instead of buying a couple steaks, I'll buy an entire striploin and cut it into steaks myself. Or walking out of the supermarket with a whole 15 pound salmon. :)

I'm well aware that would happen. The point is to make meat consumption more difficult.

[MKSheppard]

It's funny how the voters basically write a blank cheque to government for anything that is related to the military, but they think it should subsist on air for everything else it does. It appears that it's OK in America to tax people in order to end lives, but not to save them.

It's because you can hug nuclear munitions, and all sorts of other sundry munitions, but not scalpels.

[Illuminatus Primus]

IP, if you start taxing things, you give the government incentive to keep them legal to keep the revenue stream open. They won't want consumption to completely end, because they'll be making money off of the tax.

Which is why I said ban transfats at least, and discourage or ban HFCS. Then institute taxation controls, as opposed to your sumptuary laws. Furthermore, they're not really making money because consumption of unhealthy food is proportional to social costs on the system.

[Broomstick]

In some way, this situation seems to be directly analogous to the idiots who are out of homes because they took on stupid mortgages. If they're going to make poor choices, then why should they expect society's support when those choices come back to bite them in the ass, as long as they're not going to die?

Any thoughts?

If society is funding the healthcare then the question becomes which is more cost-effective for society - fully funding care for the overweight and obese from the first sign of trouble, versus waiting until expensive end-of-life care is required.

Part of the problem in answering that question is that there is no sharp dividing line, you don't go from 100% healthy to corpulent invalid by going from, say 250 to 251 pounds. Early intervention also makes sense among groups that are highly at risk, such as the Pima tribe of Arizona, but would involve things that are not normally considered "healthcare" such as convincing them to change dietary habits, as well as getting whitebread America out of their cares and moving under their own muscle power on a regular basis.

It may well be that, over the long haul, it's actually cheaper to pay to cover the consequences of stupidity earlier rather than later, however frustrating that may be to some folks.

Remember that in Glorious Capitalist America, we don't believe in solving problems directly if that means we must admit that government is in the business of solving problems. In Glorious Capitalist America, government itself is the problem.

What's this "we" shit, Wong? When did you become part of the Evil Empire? (Although we're happy to have you here on the Dark Side.... bwa-ha-HA!)

[Gil Hamilton]

I don't think you people who are happily writing laws and taxes to ban unhealthy things are getting the root cause of the obesity problem. The problem is not the food, particularly (even if high fructose corn syrup is the White Man's Poison). The problem is the culture, with normal sized portions being considered weak and mass market junk food everywhere as big business. Crass consumerism is the overarching problem. If you go around banning and taxing things, people will get them anyway one way or another or gorge themselves on something else. The solution isn't having a competition to who can conceive of the most draconian laws to get rid of the evil stuff, because it doesn't address root cause. Besides, has prohibition ever really worked that well?

However, one thing that could be done if we are talking laws rather than social engineering is to quit subsidizing corn to the degree that the government does via the Farm Bill. End subsidize there and shift them to healthier vegetables, which are less terrible for humans and the environment. One of the main vectors for obesity is that junk food, which is basically processed corn and soy, is absurdly cheap due to government subsidy while healthy fruits and vegetables are expensive. Target corn and soy and shift those dollars make fruits and vegetables (on a rotating basis based on the season), and you'll go a long way to making healthy foods more available to everyone without banning anything.