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Tax the Unhealthy – Lazy Man’s Thoughts

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[This is my response to a two-part guest post by Adfecto of Aspire 2 Wealth. You might want to read both part 1 and part 2 before continuing. The topic is controversial and as I imagined it drew many strong feelings from commenters]

I'd like to address a few of the main points that Adfecto made in the two articles.

Who determines unhealthy people and how? If we decide they should pay pay extra, how much?

I think Adfecto answered these questions later on... "an actuary could create a formula." He is quick to point out that it would be based on "an imperfect model of disease and medicine." I'm fine with an imperfect model. I don't think that any insurance is a perfect science. If you look at car insurance rates and credit scores these are attempts to quantify based one what we do know about the facts. It doesn't have to be perfect to be very effective. However, the most obvious parallel to me is life insurance. Don't actuaries for these companies quantify health and life expectancy already?

Could you get kicked out of the your life insurance?

I don't think anyone should be completely uninsurable. This would be a place for politicians to step in and make sure that everyone is insurable and that there's a reasonable cap on rates. Even if someone was born with something that costs millions, it should be subsidized by higher rates for the healthy people. So even you are the most unhealthy person in the US, perhaps you pay only 20% more than the most healthy group.

What if you were genetically predisposed to being unhealthy?

I think there are few people born into perfect genetic health. My wife has high cholesterol. My family has a history of a rare genetic thyroid cancer - which I might have. I'm okay with having to pay on the unhealthy spectrum if a test determines that I do have the genetic trait.

Do unhealthy people really cost more to insure?

After reading the block of comments and articles, I still say yes. If some people die of heart attacks right away and their cost is zero, that's great. However, a significant number do live and need treatment. The best way to save money on health care is to not need it. There was an argument about living longer requiring people to require more treatment, but they are paying health insurance premiums over this longer life.

A frequent commenter, Kitty, asked for real evidence that it costs more to treat the unhealthy. I think that was a great point. However, can't I turn it around and say, "Where is the evidence that it costs the exact same amount for each person's cost of health medicine and procedures?" I think you have to look at all the studies and see what conclusion is most likely. It seems like there are a few studies that say it's cheaper to be unhealthy and many more that go into the expensive costs of chronic diseases. One great example was that runners may require knee replacements. I'd counter that with obese people needing knee replacements (my father-in-law had the procedure after years of carrying his 300 pounds, for example). It may turn out that it balances out and the runner is left with a healthier heart due to his/her fit condition.

Another couple of people (Brandon and Writer's Coin) noted that there should be discounts for people who make healthy lifestyle choices. My problem with this is that it's the same as taxing the unhealthy - it just depends on the view. By giving a discount to those who are more healthy, the unhealthy are paying more than the average person.

A Two-Tiered Proposal

I mentioned above that health could be quantified to the best our abilities. That number could be used to determine where on the health spectrum you fall. If you were more unhealthy than the average number, you would pay a percentage more. If you were more healthy, you'd get a discount. I proposed the number to be capped at 20% earlier, but I don't know if it's the right number. I'm just giving an idea, not an exact implementation.

The other idea is that I would "tax" people at the source. There is already a significantly high cigarette tax, but I'm not convinced every penny of that money is going directly toward stopping people from smoking or towards curing lung cancer. Step one would be make that happen. At some price the cost of the cigarettes pays for the health care of the person smoking.

I would add a fat tax for foods that prove to be unhealthy. If high-fructose corn syrup and trans-fats are cheap, there should be a tax on them to pay for obesity related problems they cause vs. natural alternatives. Here's an example of a broken system, it can cost $5 for a salad at McDonalds while a double cheeseburger is just one dollar. To encourage people to make healthier choices shouldn't the salad be closer to $1.50 and the double cheeseburger $3.50? I'm usually against the government stepping in, but I can't see a better solution.

Perhaps in the future people can opt-in to a program that measures how much exercise they get and could get a discount based on that. Perhaps the treadmill stores workouts on a smart card. The only problem is that it would be hard to measure everyone's preferred exercise - I don't know how to measuring distance swam for example. However, it's an idea even if it's not quite practical now.

Maybe I miss the point with this two-tiered proposal. Adfecto correctly points out that "insurance is suppose to spread risk and keep health care expenses predictable and manageable for everyone" while I'm looking at it as a way to motivate us to be more healthy. I think that my proposal does both, while everyone paying the same only makes it "predictable and manageable" for everyone.

Posted on February 22, 2008.

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48 Responses to “Tax the Unhealthy – Lazy Man’s Thoughts”

  1. Adfecto says:

    Lazy Man,

    You’ve presented some great ideas to balance some difficult issues. I think one day these types of approaches may become reality. A 20% cap either up or down is something that I could live with too. Thanks for the opportunity to have this exchange of ideas.

  2. Bill says:

    couldn’t have worded it better myself.

  3. Ron says:

    Why don’t you just cut out all the nonsense. Take your model for figuring out the unhealthy among us and cut them off from all life-extending medical care. Then you will really save in premiums.

    This entire issue is ludicrous.

    You cannot compare car insurance to health insurance. We do not charge risky drivers more for insurance in most cases. If they post a bond in most states with the bare minimum in liability coverage they can drive. Besides, car insurance is not high for bad drivers because they bang up their junk cars. It’s because they pose a risk to others. Where is the risk to others because I eat a cheese burger with a vanilla shake?

    You are making assumptions about health care costs that have not been proven and you really cannot support with hard numbers. But with this idea in mind, you want to tax legal activities to pay for the supposed cost of the unhealthy among us. Ridiculous.

    And your proposal to essentially “tax” people with pre-existing conditions with higher premiums? That’s about the coldest thing I’ve read in a while.

    What’s the answer? It’s not the government. Let the medical community start running their business like a business, which they do not do now because of government intervention and lack of competition.

    Here are a few ideas:

    Allow comparison shopping among health care providers. The cheapest guy gets to fix my ingrown toenail. We cannot do this now because of restrictive health care policies trying to price fix everything.

    Use catastrophic policies for the really bad stuff and pay out of pocket for everything else. And just like pulling up at the gas pump or your nearest college dorm, you pay before you play.

    And the people who TRUELY cannot afford health care? We will still take care of them. Any good society would. But we do more than that now. We pay for people who simply refuse to work.

  4. Lazy Man,

    When I first read Adfecto’s posts, I passed on commenting because his thoughts were all over the place and completly ignoring the elephant in the room: the ‘insurability’ issue you guys are going over and over again.

    Let’s look at the real issue, it’s not insurance, it’s the cost of medical care. Insurance companies are only passing on the cost of medical coverage + a profit margin + administrative costs. Insuring everyone is not going change anything until someone addresses the underlying costs and makes the dispensing of healthcare more cost effective.

    Before we discuss universal coverage, let’s get Congress to pass some other common sense changes:

    Require standards in medical records and claims billing. Require electronic price lists from medical providers.

    Make medical records portable on electronic devices: a 4GB thumb drive cost around $25, that should be more than big enough.

    Require hospitals, doctors & pharmacies to institute quality control initiatives. Google staph infection if you think quality is not an issue.

    Encourage more doctors to enter GP or family practice. Offer low cost student loans that can be forgiven if the treat people whith cronic conditions that keep them from working. Treating medical problems at the GP level is tremendously cheaper.

    Any one of these initiatives will save hundreds of millions of dollars.

    Why is the cost of medical coverage not a bigger issue? Because 85% of the country has either goverment provided or employer provided coverage. Anyone with insurance pays only a fraction of the real medical costs. It’s like going to McDonalds and paying $1 for a value meal. Imagine going to the best steak house in town and paying $20. It’s cheap to you, why complain about the price?

    Address the real issue and insurance companies will be glad to offer policies at affordable prices.

  5. SJean says:

    “By giving a discount to those who are more healthy, the unhealthy are paying more than the average person.” It isn’t quite the same–you said the discount was for healthy lifestyle choices, regardless of the results. It eliminates the “genetic” factor.

  6. Lazy Man says:

    Ron: I might have lived in weird states, but risky drivers are charged significantly more. I have a friend who pays 4 times as much as me in Massachusetts.

    Many have said that the risk to others because by someone eat unhealthily is the lack of being able to get good health care. The theory is that because people are so unhealthy now, insurance premiums have skyrocketed, and some are left unable to afford coverage. If more people were healthy, insurance premiums could be cheaper. That’s the research I’ve read a number of times.

    “You are making assumptions about health care costs that have not been proven and you really cannot support with hard numbers.” Can you support the assumptions that everyone should pay exactly the same with hard numbers? There are no hard numbers that are irrefutable for either case so why is the one I propose any less viable than the one you propose?

    “But with this idea in mind, you want to tax legal activities to pay for the supposed cost of the unhealthy among us. Ridiculous.” How much cigarette tax do you pay for the legal activity of smoking. Do you think that tax should go to libraries? When you pay a bridge toll, the costs of the toll supposedly (unfortunately not all the time) go to repairing the bridge from the wear of driving over it. If my suggestions are ridiculous, millions of people already agree to them today whether they like it or not.

    Ron, I was including myself and my wife in that pre-existing conditions group. If I’m being cold, I’m first in line. Plus I’m only suggesting a maximum of 20%, it’s not a huge amount. And you still would have the power to offset that being healthy in other areas of your life. My wife’s high cholesterol could be balanced by her great diet and workout schedule.

    InsuranceYak: I agree with you. Having worked in a hospital the room for cost savings everywhere is enormous. I keep waiting for technology to catch-up, but it always seems to lag behind.

    SJean: I guess you are right about it being for healthy lifestyle choices. It’s just hard or impossible to measure that. If I say that eat organically that’s considered by many to be a healthy lifestyle choice – do you give me a discount based on my word? If I go to gym everyday, but sit in a hot tub do I get a discount for a healthy lifestyle choice? How do they know if go to the gym and work out or not? It’s pretty hard to measure these lifestyle choices except to take people’s word for them.

  7. M says:

    This is absurd. Here’s why:

    1. “I mentioned above that health could be quantified to the best our (sic) abilities.” That assumes that all illness is caused by lifestyle choices. But what about autoimmune diseases? You may only think of AIDS, but there’s a slew of others: Parkinson’s, multiple sclerosis, rheumatoid arthritis, and lupus to name a few. You can eat your 5 a day and maintain the most desireable BMI and still get any of these diseases. I know this all too well: my mother died of a very rare autoimmune liver disease, and she didn’t drink. Not all diseases are genetic.

    2. Your “fat tax” would penalize the poor. Why? Go to any low-income urban area and you’d be hard-pressed to find a supermarket with quality fresh vegetables. You will find plenty of fast food places. In an ideal world, things would be different. But first, work on getting quality food to places that don’t have it.

    There’s a lot of reasons why healthcare’s so expensive. First of all, there’s a big 80/20 rule: 20 percent of people incur 80 percent of health care costs. See research from the Kaiser Family Foundation. (Oh, and I’m pretty sure that not all of the 20 percent are obese. BTW, people who are fat in old age fare better than the skinny. One of the medical journals recently published an article to this effect.)

    Furthermore, nobody really knows what healthcare actually costs. Some of the pay for performance initiatives are trying to get at that. In the meantime, insurance companies pay a certain amount to healthcare providers and facilities, and who knows how much padding goes on with those figures?

    Additionally, medical errors incur a lot of healthcare costs. This includes wrong-side surgeries, but also pressure ulcers and infections. The government and (I’m pretty sure) insurers won’t be paying for these anymore. But I’m sure hospitals et al will figure out another way to pass costs on to consumers.

    I’m not saying that I have the answers, and thus I commend you for taking a stab at it. But the system itself is broken, and “personal responsibility” isn’t going to fix it.

  8. Lazy Man says:

    M:

    1. I addressed genetic diseases. My wife’s cholesterol is genetic. My potential thyroid cancer is 100% genetic. I make no assumptions of it being caused by lifestyle choices. I’m saying that I’ll stand up and pay more because there’s a good chance I’ll require more help – even though my and my wife’s lifestyle choices are good. And who knows, maybe the actuaries decide that our overall health is better than average due to our lifestyle choices and we end up saving money.

    2. Okay, perhaps my “fat tax” could be used to get quality vegetables to the places that don’t have it. I’m not familiar with these places, but I have to figure that if we are collecting more money for bad food, we can make good food more available. I think my plan would actually help the poor. There are many who are probably subsisting on nutrition deficient Ramen noodles because they are cheap.

    I don’t disagree with the 80/20 rule and I’m sure not all 20% are obese or smokers. I’m guessing that between those two groups and those with genetic issues like myself make up a good portion of that 20 percent. I’m sure that age is in there as well, but we can’t just say, let’s get rid of the old to save costs… not exactly a viable solution.

    “Furthermore, nobody really knows what healthcare actually costs.” This has been my point throughout. People say that I can’t say the unhealthy costs more money. I say that others can’t prove that everyone costs the same amount :D.

    Obviously our goal should be to limit medical errors as much as possible. This should be done in addition to anything else. As you mention the system is broken.

  9. Interested Reader says:

    Cool idea! Can we extend this to also tax the ignorant and unintelligent? Maybe a surtax on books with a low reading level to help compensate for the higher educational costs. Or just a tax on big screen televisions, video games and pop music would broaden the base to include the illiterate? Even a one cent charge for every spelling, punctuation, pronunciation, grammatical or computational error would seem to be a step in the right direction.

    Oh yes, and higher fees for those with mood disorders. AIDS patients need to pay more, too! And I’m really sick and tired of the terminally ill cancer patients getting off so easy.

    Don’t you Ayn Randian Aryan supermen have any compassion for anyone else in the world?

  10. Lazy Man says:

    Interested Reader: With my possible genetic thyroid disease, I’m putting myself in the cross-hairs first. Like I say, I’d be the first to step up and take he surcharge for others. It might be different if I had something to gain, but I have the most to lose.

  11. M. says:

    Lazy Man,

    Re: your “1.” response to my comment – My point here was that autoimmune diseases are *not* genetic. It’s great that you and your wife know your risk factors and can manage them accordingly. But a lot of chronic diseases are autoimmune disorders that are expensive to treat (including medical care, pharmaceuticals, durable medical equipment, etc.). Like I said, people who do all of the “right things” get autoimmune diseases.

    The instinct might be to say, OK, your plan will make a special concession for folks with autoimmune disorders. But then you might exclude this concession for AIDS, because personal behaviors can factor into acquiring the disease, so they get lumped into your group who you believe eats Ho-Hos all day long. Nah, doesn’t work for me. Playing superior being in a society in this manner is unsettling, to say the least, and there’s many examples from history to back that up.

  12. kitty says:

    ” It seems like there are a few studies that say it’s cheaper to be unhealthy and many more that go into the expensive costs of chronic diseases. ”
    Where are these “many more studies”? If you try to look at studies on cost, you’ll notice that many of them talk about cost-effectiveness of something rather than cost-savings, where a measure is considered cost-effective when the cost of Quality-Adjusted Life Year (QALY) is under 50K. While most of us would be willing to pay 50K for a good quality year of our life, it is not the same as savings. There are ZERO studies showing that so-called unhealthy cost more. There are studies of how much treatment of some conditions costs, but there are no studies of how much the lifetime cost of standard preventive care for the healthy cost in comparison. Dutch study is the first study that attempted to look at that issue, and we all know what it showed. All you have is “intuitive feeling” or “it is obvious”. You say that overweight people needing knee replacements cost more – how many overweight people need knee replacements compare to how many runners? How many people of those that “cost more” are obese, for example.

    “People say that I can’t say the unhealthy costs more money. I say that others can’t prove that everyone costs the same amount ”
    But “others” don’t argue for taking actions against “healthy” because they may cost more. It seems to me that the burden of proof should lie on those who want to act on their beleif.

    “Some of the pay for performance initiatives are trying to get at that. ”
    You should really look at some doctors’ blog to see what they think about those. The main problem with these initiatives, as well as models for insurance is that people who come up with them have complete lack of any rudimentary knowledge of epidemiology, including basic concepts like the difference between absolute risk and relative risk or Number Needed to Treat, uncertainty of science behind the guidelines and individual variability. We are a whole lot more complex than cars.

  13. kitty says:

    “people who do all of the “right things” get autoimmune diseases. ”
    Actually “people who do all of the ‘right things'” get all deseases – heart desease, cancer, autoimmune conditions. All one talks about is an increase or decrease in risk, and with the exception of smoking this increase or decrease in risk isn’t that drammatic. These 20% mentioned above includes a lot of people with no specific risk factors, just bad lack as well as old people getting end-of-life care. Sure some thing may increase or decrease this risk. But by how much? Smoking increases the risk of lung cancer by 1000%, but most smokers still don’t get lung cancer; besides most smokers already pay more for health insurance. Nothing else – obesity, cholesterol, etc. comes close to smoking in terms of risk increase. Some genetic traits significantly increase the risk of some deseases – sometimes by a lot, more often by a little, but most people who get sick don’t have any risk factors. If you try to make actuarial model for risk and costs based on real evidence and not wishful thinking and the desire to feel “empowered” you may be very surprised by the results.

  14. Ron says:

    Lazy Man,

    Not to belabor the car insurance point but your friend is paying higher premiums because his record indicates the higher probability that he could hurt another person or their property while driving, not himself. On top of that, I would bet he has coverage that is comparable to yours not the bare minimum I suggested. Of course he is paying more.

    Your point that there is “risk” to others because unhealthy people have caused insurance premiums to skyrocket is not well taken. People without insurance this very day receive medical treatment when they need it. We aren’t stepping over the dead bodies of those not carrying a policy in their pocket. Is that cost passed on to us? Certainly. But you would be hard pressed to tie that to what you deem an unhealthy lifestyle.

    And I don’t have hard numbers to counter what you have written. The point is you don’t have them.

    As far as your extra tax for lifestyle choices, I don’t think there should be an extra tax on cigarettes (and no, I don’t smoke them). So, no, the libraries shouldn’t pay them. Repair a bridge and everyone benefits so that is a fair tax. And the fact that “millions” agree with you does not make what you are suggesting right. The masses have followed leaders in the past that turned out to be despotic and evil. They weren’t right either.

    With all due respect to you and your wife, the fact that you want to include yourselves in this scheme in no way makes it more palatable. What if you never have to go to the doctor because of your pre-existing condition? It’s still there but it never presents itself for needed treatment. Do you get your money back? What if you have no pre-existing condition but then lung cancer desimates you for six months and finally kills you. Do we charge your estate for all the missed premiums you didn’t pay?

    The bottom line is this is unseemly and rather Orwellian and it’s pretty sad that “millions” are even considering it.

  15. Lazy Man says:

    Let me start off by saying that I love this discussion. I’m learning much more in this past week than I have over entire months of writing in the past.

    M: My wife might be able to manage the risk factors of her high cholesterol. My thyroid thing (if it does fall down the family line) is something that I think may fall into the I “do all the right things” and get cancer (well I’d get surgery first because I’m lucky enough to know about the condition). I think you do have a point though. I guess I’d have to go with, an actuary can take into account if a person is doing “all the right things.” I’d be curious to how life insurance pricing works with people with autoimmune diseases. I’m not in that business, but I suspect they might either deny coverage or charge me more.

    I’m sure my system wouldn’t be perfect, but perfection is the enemy of progress. I’m not even sure if it’s progress, but I would suggest that it seems like progress in encouraging people healthy behavior.

    Kitty:

    I’ll grab an example from the CDC, The direct and indirect costs of diabetes are nearly $132 billion a year. Some forms of diabetes you can’t do much about. Others can be controlled or prevented with healthy lifestyle choices. It is the others that I’ll reference here. I don’t know if anyone has done a study of the cost savings between having to treat someone with diabetes and not having to be treated with diabetes. And if you want to go down the path of shorter lifespans of people with diabetes, you need to account for lost productivity of that person as well the doctor who could have focused his time on curing another disease.

    Knee replacements – Kitty, I’m sure someone has this number. It’s not my business for having it, but my point is that it’s easily measurable. I can show you that obesity may affect the success rate of knee replacements. If runners have a greater cost of knee-replacement, the actuary will give them a plus one in that column. However, they’ll likely get a 0 in the other pile that obesity is linked to.

    Ron:
    I think a large part of car insurance is damage to others, but it includes yourself as well. People with cars that have automatic driver-side seat belts get discounts on their insurance.

    “People without insurance this very day receive medical treatment when they need it. We aren’t stepping over the dead bodies of those not carrying a policy in their pocket.” Actually, in a situation very close to me, two people have died on the floors of emergency rooms in Los Angeles recently. They didn’t get medical treatment when they needed it. I’m not sure if they had insurance or not, but if you imagine a healthier world in general the emergency “may” not have been as crowded.

    Again, for all I know, too many people just had bad accidents that day. However, imagine a world where 90% of the world is severely unhealthy… do you think the 10% could tend to them? Imagine it switched and 99.99999% are “doing all the healthy things.” Wouldn’t you expect the odds of getting treatment to be higher?

    “And I don’t have hard numbers to counter what you have written. The point is you don’t have them.” I think the point is that they don’t exist for either of us to have them. I don’t have confidence that the numbers could even be attainable. I think it just might be too complex to have a controlled study. If we can get numbers that a significant majority would agree with, we should do that and act on the basis of what those numbers say.

    If it’s as I suspect, not possible to get numbers that a significant majority would agree with, then we have to make a choice without numbers. One could say the default of everyone paying the same makes sense. Another could say that having the cost weighted by an unbiased third-party makes sense. The later has a benefit of encouraging healthy behavior.

    “The fact that ‘millions’ agree with you does not make what you are suggesting right.” That’s an excellent point.

    Ron your final questions (not repeated for brevity) are interesting. It is health insurance we are talking about here. The goal isn’t to make sure that everyone pays exactly what his/her cost would be.

    I would like to ask all those opposing the plan I suggested not focus on the numbers that probably can’t be measured reliably either way – even if our intuition tells us that an ounce of prevention is worth a pound of cure. I would ask all if it encourages people to live a more healthy lifestyle. If you say no, then let’s discuss why that may or may not be. If you suggest that we might want an unhealthy society, I would love to hear more. It seems like a curious stance to take.

  16. Ron says:

    Lazy Man,

    Let’s dispense with the car insurance rationale. It has some merit to your point but there are enough apples and oranges in the argument to deem it moot.

    I would like to get to your larger question: Would your plan encourage people to live a more healthy lifestyle? The short answer is yes. The government could make access to health care so restrictive that people would be forced to change the way they live in order to sustain a longer life with the assistance of medical care. Not all would do so. I certainly would seek out ways around it because of my personal belief system. I would sacrifice quantity of life for my definition of quality of life. Others would, too. Black market health care would surely ensue. And certainly more sickness and death. A free man will tolerate the government telling him what he can do with his body only so far.

    Look at prohibition. The government attempted to control a lifestyle choice by outlawing alcohol consumption. Did it work? No. It was the prime example of a road being paved with good intentions. The government finally realized living with alcohol and all its attendant ills was better than trying to restrict its use.

    The weak point to your argument is this: Our society will always care for those who act irresponsibly. I may think we do it to a larger degree than we should but I do think a good society must endeavor to do this. If this is true, what will you do to maintain your plan? Jail those who refuse to ride their bike to work for greater health? The stockade for those who smoke cigarettes and eat red meat? Perhaps just a fine for someone refusing to exercise three hours a week? Of course, I know you would not agree with this. I am being facetious. But really, what would you do to force those who do not agree to adopt your plan?

    This is my ultimate concern: I don’t want you or my neighbor to control what I do with my body as long as I am not hurting you or violating your rights. If I am doing that, you have a say, and frankly, you can use what ever measures you deem fit to stop me. If all I am doing, to a very very small extent, is raising the price of your health insurance premium, I’m sorry, you will have to deal with it. It is a fair trade for the freedom we all share in this country.

    You have started a good debate. And while I don’t agree with you I have great respect for your ability to stand up for your opinion. You’ve certainly caused me to do a lot of thinking about this issue. If you do nothing else, you’ve done more to help solve this problem than I have. For that I thank you.

  17. Lazy Man says:

    Ron:
    I don’t think the car insurance analogy is different enough to dismiss it as moot.

    I don’t think my plan makes health care more restrictive or supports a black market. I don’t know where the basis of this is coming from. It’s not like I’m saying that the unhealthy have to pay 1000% more than the average and the healthy pay 1%.

    I don’t see the prohibition argument. I would not be banning anything. My plan is just a shifting of cost to encourage good health. As long as we are on alcohol, many (perhaps most) states already place a tax on it (for better or worse). It’s not treated the same way as a gallon of milk.

    I don’t recommend that we stop caring for those who act irresponsibly. I am not saying that we drop their coverage or anything of that sort. I suggest a very small difference in health insurance premiums similar to what smokers already pay for life insurance (but a bit broader in scope). What do we do with people who do not agree to adopt my plan? What do we do with people who don’t pay their health insurance today? It’s exactly the same.

    One point I’d like to stress is that the way a person takes care of him or herself DOES impact the health of others. If 80% of the people in US suddenly came down with a debilitating disease, do you think that wouldn’t impact you? If you got strep throat, do you think you could get a doctor’s appointment? I’m using an exaggerated example here as well (and one that can’t be controlled, but that’s irrelevant).

    If one person being unhealthy impacts things a “very very small extent” (to use Ron’s words), what happens if America has 200M unhealthy people vs. say 25M unhealthy people. I think that it might add up.

    In the end, Ron may be right. Freedom is one of our biggest assets. I’m using a big part of that freedom to be able to write this. Maybe it’s the wrong proposal, but that’s not for me to decide.

  18. kitty says:

    “I’ll grab an example from the CDC, The direct and indirect costs of diabetes are nearly $132 billion a year. Some forms of diabetes you can’t do much about. Others can be controlled or prevented with healthy lifestyle choices”

    Again, you are confusing the cost of treatment of a specific condition, with the comparison of lifetime healthcare costs between obese people as a group and thin people as a group. We know that obesity significantly increases risk of type 2 diabetes. What it means is that if you take a group of 1000 obese people and 1000 thin people, a higher percentage of obese people will get diabetes than in that of thin people, so the treatment of diabetes and its complication specifically among the obese will indeed be higher among the obese. But this extra cost will be offset by the cost over the lifetime of the group of healthy people living longer and getting some other deseases like Alzheimer and osteoporosis at the end since obese tend to die sooner.

    As to knee replacements, again you lack numbers. OK, athletes recover sooner, good for them. Doesn’t mean the total cost of knee replacements as well as other injuries (e.g. fractures) for runners is less than that for obese. To figure this out, you need to know the percentage of obese that require knee replacements and other injury treatments, the percentage of runners that require injury treatments, what are the costs. What about osteoarthritis? Being overweight and inactivity is a risk factor, but so is overuse – running, high impact aerobics, step. Which group is in greater risk? Before you make policies, you need actual numbers.

    This comparison is what the Dutch study attempted. At this moment this is the only study that specifically compares lifetime healthcare costs across different populations. So, no, your link isn’t evidence that those with unhealthy lifestyle actually cost more. Estimating cost of treatment of a specific condition for which one group is at higher risk (lung cancer, diabetes) isn’t sufficient.

    You say that extra years of life means extra insurance premiums. This is an excellent point, but again what you lack are actual numbers to accurately determine if the cost of additional years of life is offset by these additional premiums.

    Regarding charging higher taxes for cigarettes and “bad” food. It is already done for cigarettes. Personally, I couldn’t really care less about the cost of cigarettes – if it gets too expensive for my neighbors to buy cigarette, good for me. As to food, 1) the definition of good and bad food changes as more evidence emerges: a few years ago they told us eggs were bad, now it turns out there is no evidence of any harm from eggs; it used to be potatoes and all grains are great it’s the stuff you put on it that is bad, now it is potatoes and refined grains that are bad because they raise blood sugar and predispose one to diabetes (btw – if you don’t agree with this – see link below). Notice also, that WHI study which was a large randomized controlled study showed no benefit in low-fat group (the link to discussion of study results – http://www.jpands.org/vol12no1/ottoboni.pdf). Who know what evidence is going to emerge in future and in the meantime some people may be harmed. Like my mother who stopped eating egg yokes and now it turns out that they have a lot of lutein which may actually retard macular degeneration. Who knows if my mother would’ve have a few more years of good vision if she had eaten more eggs? 2) this will never fly because of special interest groups. Look at FDA food pyramid and compare it to the one from Harvard School of Public Health ( http://www.hsph.harvard.edu/nutritionsource/pyramids.html ). Why didn’t FDA clearly separated good/bad carbs? Could the one reason be all these special interests like potatoes farmers? Why is refined wheat, corn sirop and hydroginated oil cheaper than fruits? Could it be because of farm subsidies? Here is another thought. Wouldn’t eliminating farm subsidies work better than taxes?

  19. Lazy Man says:

    Kitty: I don’t think we’ll ever be able to quantify the complexities of the 1000 thin people vs. the 1000 obese people. I would like to read the Dutch study, but I can’t seem to find the text and methodology. I’d love to see how they quantified the productivity of the person who lives longer.

    Knee replacements – I agree that I lack numbers (I said this much). I invite readers and researchers to study this as much as possible. Perhaps we can quantify the knee replacement issue. This doesn’t seem too complex.

    Kitty says that I need numbers before making policy. I would buy that. Which numbers were used when the policy of paying the same was made? I want to make sure that everyone has exactly the same chance of health costs in the future.

    I had pointed out that the tax is already done with cigarettes, I’m just not sure that all that tax revenue is used to improve people’s health. I couldn’t tell you if it does or not. If it does, great nothing needs to be done there.

    Today’s “bad” food might not be tomorrow’s. I have no problem with that being the case. I think we have to act on what we know today and not worry about what we might learn tomorrow. We should simply adjust to that knowledge when it comes – it’s the best that anyone can do.

    Eliminating farm subsidies may work better than taxes. I don’t know enough about how farm subsidies work to opine on it. My goal is simply to make good foods cheaper than bad foods. It may be accomplished through many different means – my point is that it should and can be done.

  20. M. says:

    Before I stir up the pot again, I concur with Kitty’s comment re: the food pyramid. I happened to see a Congressional hearing about 5 years ago re: the food pyramid. Dr. Ornish (low fat), someone from Atkins (low carb, of course), and some others I can’t remember testified, all advocating their own point of view being the superior one. I just finished reading a book called “Real Food: What to Eat and Why” that makes a compelling case that eating natural saturated fats are good for you. My take on the food pyramid is akin to what Bill Maher once said about alcohol being legal and pot being illegal: the alcohol people had a better lobby. I’d venture to guess that special interests also factor into the food pyramid.

    OK, now for pot-stirring: we’ve only been talking here about physical illness and the impact of a healthy lifestyle. What about mental illness and its impact? Despite the fact that it’s well-proven that mental illnesses can and do cause physical illnesses, insurers to this day curtail coverage of mental health treatments, either by visit caps or dollar amounts, even though mental health parity coverage is supposed to exist. See the first goal of the report from the federal Mental Health Commission: “Americans Understand that Mental Health Is Essential to Overall Health” – http://www.mentalhealthcommission.gov/reports/FinalReport/FullReport.htm

  21. Hosptal CEO says:

    Ernesto ““ let’s be honest here. I’ve dealt with plenty of insurance companies and their tactics to know that it isn’t just the providers (hospitals and physicians) who are responsible for increasing health care costs.

    “Insurance companies are only passing on the cost of medical coverage + a profit margin + administrative costs.” Correct, but we need to understand what goes into each one. Profit Margin ““ shall we compare profit margins of the insurance and hospital industry? I’ll assume not. Administrative costs ““ in my experience, if their costs go up, so do their premiums. Costs of medical coverage ““ Lets take this example: I run a 24/7 operation, physician ER coverage costs my hospital $85 per hour, and I’m required to have millions of dollars of equipment available for whoever walks in the door. My hospital cannot discriminate based on ability to pay. Do insurance companies discriminate based on ability to pay?

    One of the large insurance companies that my hospital contracted with would not give their fee schedule. The fee schedule is the table that tells us what we’ll be paid for certain procedures. If I don’t contract with them, I’ll have thousands patients furious that I no longer take their insurance. The insurance companies know this and use it to their advantage.

    “Require hospitals, doctors & pharmacies to institute quality control initiatives.” Each state has an agency responsible for reviewing quality at hospitals. This agency requests patient charts and records on a regular basis. There are plenty of quality improvement initiatives going on in hospitals. I believe physicians are immune from most regulation by the state ““ they have a very powerful lobby. Pharmacies ““ your guess is as good as mine. Google is your reference?

    “Encourage more doctors to enter GP or family practice. Offer low cost student loans that can be forgiven if the treat people whith cronic conditions that keep them from working. Treating medical problems at the GP level is tremendously cheaper.” Doctors are given forgivable student loans to enter primary care. Since this is a finance blog ““ if you had the option to make $120,000 per year or $250,000 which would you choose? I’m offering a $10,000 sign on bonus for a GP and a $50,000 for a urologist. Talk to the consumers. Generation X’ers want a specialty doc. Honestly if I’ve got a broken leg my GP had better send me to an orthopedic surgeon, I want the best, not the cheapest when it comes to health care.

    Insurance companies are glad to pass on the cost of health care with their profits attached. No one can deny that. It’s just to easy to blame the hospitals and physicians.

  22. escapee says:

    I find this entire idea to be very distasteful. We used to be a nation that has a sense of community. When your neighbor was sick you’d check in on them to make sure they were OK, maybe take them a bowl of soup. We had safety nets built into our society, that while maybe not benefiting each individual in a direct way, were there for the good of us ALL should we ever need them. The slow erosion of this and the “I’m going to look out for #1, and I want what is MINE” attitude that is prevalent now has been and will continue to be disasterous to our society as a whole. When everyone is looking out for #1, who is there to look out after the most vulnerable of us all, the poor, the old, and the very young? This isn’t the society that I want to live in.

    The basic idea of any type of insurance is this: “Bad things can happen to anyone. If you’ve got my back, I’ve got yours.” What ever happened to caring for your neighbor and fellow man? This isn’t just about money, this is about basic human decency.

    I personally *have enough*. I’m healthy and can feed and clothe my family. I’m OK with paying a little bit more to have YOUR back should you need my help.

  23. Adfecto says:

    @ escapee

    Thank you for putting into words so clearly the essence of what may be the most important point of the whole debate. I tried to stay that by referring to “sharing risk,” but you said it better. We are all in this together; we should act like it and be willing to contribute equally to our community.

    Unfortunately, we seem to have become truly a country of selfish whiners that must get a “gold star” for their specialness (such as nebulously defined healthy lifestyle). In the interest of consensus and to avoid a complete breakdown of the system, I could stomach a 10-20% higher rate (beyond this pricing delta and we loose too much of the “shared risk” imho). I would still ask if you can present me rigorous scientific data that supports the price difference (contradicting the Dutch study), but I doubt this is realistic at this time with our limited understanding of disease.

    Thanks for the debate; it’s been fun.

  24. Hospital CEO:

    I’m sorry was Google not a good enough reference to show quality issues are a problem with American hospitals? How about the New England Journal of Medicine?:
    http://content.nejm.org/cgi/content/full/353/3/255

    What next? Will you correct my spelling?

    Hospitals are a mixed bag; some have state of the art reporting equipment, others they scratch prescriptions on a piece of paper. The same can be said of doctors offices.

    It’s amazing to me my music library is easily transportable and backed up in several places; and privacy? I can’t share my iTunes without giving out a password. But my medical records are who-knows-where and written on paper.

    So, if I fall over somewhere and an ambulance scoops me up and takes me to your hospital, what happens next? No access to my medical history so your hospital spends thousands of dollars trying to figure out what’s wrong. Now if they want to find out what I like listening to, they can reach in my coat pocket grab my iPod and find I have a thing for live Led Zeppelin.

    I didn’t realise transparency of insurance reimbursement was an issue. I’ll be sure to add that to my blog posts of things that should be fixed.

    Is health insurance a profitable line of business? Hmmmm lets see: Franklin County Ohio, my hometown has around 1M people and as far as I can tell around 12 major medical providers for health insurance. Contrast this with auto insurers: 680+ providers.

    Each year, there are more and more P&C and life insurance companies and fewer and fewer health insurance companies. Warren Buffet deals is almost every aspect of the insurance market except health insurance. Why? Slim profit margins. Every year, at least a few major companies merge trying to find an economy of scale.

    Truthfully, I feel for hospitals & insurance companies. The insurers are trying to squeeze more blood from the turnip in the form of higher premiums while pushing down costs when their customers are demanding specialists and the latest drug they’ve seen on TV. The hospitals are trying to make doctors, patients, insurers & state regulators happy.

    Do cardiologists really deserve double the salary of a GP? Maybe, maybe not, but if you don’t want to pay them, they’ll leave and establish a surgical hospital somewhere else; no need to deal with that pesky ER. Heart surgery is done largely to older men, a demographic that has money to pay for what they’re offering. GPs treat sniffle nose kids whose parents can’t afford large medical bills.

    At least as a hospital CEO, you can commiserate with your fat salary: http://www.hhcsinc.com/NewReleaseHSSR2006.pdf

  25. Ron says:

    Lazy Man,

    “I don’t think the car insurance analogy is different enough to dismiss it as moot.”

    Okay. In my state if you refuse to insure your car and are caught driving your license is suspended.

    We can’t suspend someone’s right to health care.

    I don’t need a car to survive. I could structure my life in a way that would preclude me from needing one. I will need medical care at some point. But unlike the use of a car, I don’t need insurance to obtain it.

    Granted, the cost for uninsured care is transferred to you and me but to stop that you would have to require that the uninsured obtain coverage.

    “I don’t think my plan makes health care more restrictive or supports a black market.”

    Your plan cannot work without government intervention. Insurance companies will not decide who among us is healthy. The government will reserve that right for themselves. Hell, the government is dying to get into this anyway because they see it as another cash cow as well as a means of garnering votes. The government does not do anything unless it is by force either through unfunded mandates or the threat of punishment. Clinton has already stated her plan calls for wage garnishment for people who refuse to participate. That is force.

    People who can’t afford insurance now won’t be able to afford it with your added premium. Here is a real world example. If I retired today (as a co-worker just did) I would pay $900 per month for coverage. Since I like pizza and cheeseburgers your 20% in additional premiums would add another $180 per month to that. At these prices, I may decide it’s just not financially viable to be insured, especially since your plan will mean pizza and cheeseburgers will cost more. Being uninsured will restrict my access to health care. If you are correct that “nothing will change”, that is I can get minimal care without insurance, then my best option would be to remain uninsured. But I don’t think that will be an option.

    The government will involve itself in my business. They will not consider my right to insure or not to insure as valid. Here is real world example of government restriction in this regard:

    Congress has banned the use of incandescent light bulbs by 2014. I pay for the energy I use even if you consider it wasteful. It is a basic private property right. But allegedly for the common good, I will no longer be able to do that. Let me add, parenthetically, I’m not trying to start another argument. It is just an example.

    Government restrictions on anything can lead to a black market. It did during prohibition. That was my point.

    I’d also like to remind you that your plan called for more than just a raise in premiums. You also suggested a fat tax and stated yourself that government intervention was probably the only way it would work. Well, the government does not and has never created anything. They take what belongs to someone and give it to someone else. It acts for the supposed good of all, not the individual. And that hurts real people. Who will be hurt? Well, the poor bastard making fries at the local McDonald’s will be out of a job. And, sadly, I’ll be in some dark seedy alley somewhere trying to score a Big Mac using a cracked Pringles lid for a plate all the while looking over my shoulder for the lights and sirens.

    When the fat tax does not work (taxing sin never has) the government will try something else. It will be a never-ending cycle of taxation that will never solve the ills it was created for.

    My head hurts. Does your head hurt?

    Ron

  26. Lazy Man says:

    Escapee: I agree with you in principle, but it’s worth noting that the “me and MINE” is largely how capitalism works. So I wouldn’t be surprised to find that kind of thinking in America.

    The whole “we have each other’s back” does exceptions when it comes to insurance. As mentioned no one pays the same car premiums. Life insurance premiums are variable as well.

    My idea isn’t about getting people’s back or not. It’s not about selfishness. It’s about motivating people to live healthy lives, something that has been heading downhill for years now.

    Adfecto: “I would still ask if you can present me rigorous scientific data that supports the price difference (contradicting the Dutch study), but I doubt this is realistic at this time with our limited understanding of disease.”

    Would you take me up on showing me rigorous scientific data that supports price parity? As you say, without understanding of disease we can’t do anything – so we have to toss numbers aside and go with something else.

    Ron:
    I don’t think I requested that we suspend people’s right to health care. I simply believe that we do what we do today… people pay for it or go without. If they go without they are on their own to pay for health care if/when they need it. The only thing that changes with my plan is the price one would pay – and it would change only a little. I don’t see how I “would have to would have to require that the uninsured obtain coverage.”

    “Insurance companies will not decide who among us is healthy.” Haven’t they already started? Isn’t that how we got on the idea of taxing the unhealthy – or giving discounts to those who don’t smoke?

    “People who can’t afford insurance now won’t be able to afford it with your added premium.” My premium is not added, it is shifted. You might pay more with your love of cheeseburgers and pizza. I would pay more as well. However, the healthy person would pay less and it would mean that they can now retire. Meanwhile you and I make the decision to eat the newly cheaper salads at McDonald’s, so that we can retire on schedule.

    “The government will involve itself in my business.” That’s what the government does if they find something that’s significantly good for the whole. This is no longer a discussion about health care, but it’s a discussion of the role that gov’t plays in our lives. I’m not going to go down a political path any more than I have.

    I’m suggesting doesn’t have the gov’t restrict anything. I’m not saying that the government is banning health care or requiring it. It’s only a shifting of price. We pay more for oil now than we did 5 years ago – we’d get used it.

    “When the fat tax does not work (taxing sin never has)”… I refer this Wikipedia reference, “It has been shown that higher prices for cigarettes discourage smoking. Every 10 percent increase in the price of cigarettes reduced youth smoking by about seven percent and overall cigarette consumption by about four percent.[21]”

    Sounds like it would work.

  27. kitty says:

    “Would you take me up on showing me rigorous scientific data that supports price parity? As you say, without understanding of disease we can’t do anything – so we have to toss numbers aside and go with something else.”

    Why should the burden of proof be on price parity rather than on price difference? If you and your friends have a shared expense and maybe some are more responsible than others but you aren’t sure how to divide it (ok, you may have guesses, but you aren’t really sure), wouldn’t you split it equally? Or would you make guesses even if your guesses may turn out to be wrong? To make price different you have to have an idea as to how different? You say it is fat people, someone else may say it is runners; most would agree the older you get the more you cost. Isn’t equal split a logical default without clear evidence?

    All you have are assumptions. You assume that fat people cost more than runners over the lifetime. Maybe yes, maybe no. If yes, runners may still cost more than those who walk.

    Additionally, you are extremely presumptious in terms of why people are fat and why they don’t exercise. You’ve no clue about individual circumstances. Certainly some people may overeat, maybe majority – we all can tell stories how we saw fat people in restaurants putting large portions to their plates. But for many people, it could be an illness, it could be a side effect of a drug like prednisone. As to the exercising – what if someone has arthritis? What if someone is working two sedentary jobs to make ends meet and is working both evenings and weekends? Most women find it very difficult to keep from gaining weight once they get close to the menopause. They can eat 1500 calories a day and exercise, and still find themselves gaining weight.

    As to the taxing fat. What if it turns out some time in future that fat isn’t actually bad for you and maybe has some benefits – just a few years ago we were told that all fat is bad; now we know that there is good and bad fat and that changed from some years ago, who knows what else may happen 10 years from now. A WHI study – a large randomized control study (!) – already showed that the “reduced fat” group of women didn’t fare any better that the controls. Sure, the study was done before anybody knew about “good” and “bad” fat, but still we don’t know what the future will show. You say – it doesn’t matter, let’s go based on what we think is true today. But as a result of your taxes, some people would not eat something which is actually good for them. If your assumptions will turn out to be wrong 10 years from now, you cannot give this 10 years back to people you harmed.

    You say that “fat” tax will make people eat healthier. But you can easily get fat without eating fat. Sugary drinks, potatoes, refined grains, will also make you fat – are you going to tax all of it? If you eat just 100 caloriesmore than you can use up, you’ll gain weight, regardless of where these calories came from. Shall we ration food?

    As to capitalism – government telling people what to do sounds a lot more like communism to me.

  28. Lazy Man says:

    Every company that I’ve worked for hasn’t been able to exactly quantify how much value I have added to the company. They make their best guess and give me a salary. Everyone is far from getting paid the same amount.

    I do have assumptions. I never said otherwise. It seems that you have assumptions that everyone costs the same. One may say the burden is on me to show that they are different, I say that it’s for the other person to prove that they should be the same. It’s a stalemate.

    I simply don’t think equal split makes more sense than the healthier getting a discount. The best case scenario from “equal split” is that costs may or may not be divided fairly. The best scenario from “healthy getting a discount” is that costs may or may not be divided fairly AND people have a financial incentive to get healthy. I’d rather live in a world where 95% of the people are healthy than one that where 95% of the people are unhealthy. I think most would agree to it.

    The “fat tax” is not a tax on “fat” it is on unhealthy foods, however we currently define it. Right now we think that high-fructose corn syrup is unhealthy. Thus it would be taxed fairly highly and the savings would be passed onto to fruits and vegetables. If five years from now high-fructose corn syrup becomes the healthiest thing in the world and fruits and vegetables become known as unhealthy, we reverse the tax and fruits get expensive while high-fructose corn syrup becomes cheap. Do you think that in we’ll keep on switching back on forth on food or we’ll refine our thoughts over time. I think it will be the later and we’ll eventually have a pretty accurate view of the strengths and weaknesses of food.

    I don’t think we need to ration food, I think the cost of food already allows for that. If I want to eat 8 ounces of beef it will be more expensive than 4 ounces. I would tax sugary drinks even if they 25 calories. It may just be 1 cent per 250 calories sold paid by the manufacturer of the food. The consumer might not even realize this tax on light snacks (i.e. 100 calorie packs), but the tax would still be collected in aggregate and used to lower the price of healthier foods.

    Kitty, I never thought about living in a communist country when the government tells me to pay social security or Medicare taxes. Maybe I should.

  29. Jon says:

    Escapee,

    You said, “We used to be a nation that has a sense of community. When your neighbor was sick you’d check in on them to make sure they were OK, maybe take them a bowl of soup.”

    Cost of soup for the neighbor: $0.30
    Cost of open heart surgery for the neighbor: $60,000+

    You really need to understand the changes that society has gone through since the “sense of community” you’re talking about was prevalent. Do you realize that health insurance didn’t even exist back then? The reason is that there WERE no expensive procedures. Fixing a broken arm didn’t break the bank. If you had a heart attack, you died.

    We’ve made incredible advances in health care and since it’s so highly specialized it costs a fortune. Everybody wants access to that highly specialized care.

    “This isn’t just about money, this is about basic human decency.”

    This is 100% about money. If all you care about is “basic human decency” then that requires nothing more than easing pain. We would not need insurance at all.

  30. Jon says:

    Hospital CEO,

    You said, “Profit Margin ““ shall we compare profit margins of the insurance and hospital industry? I’ll assume not.”

    Why not? I’d love to see a comparison. I’d love to see the salary breakdown as well, since you’ll surely deduct salaries from the hospital’s profit.

    “One of the large insurance companies that my hospital contracted with would not give their fee schedule. The fee schedule is the table that tells us what we’ll be paid for certain procedures. If I don’t contract with them, I’ll have thousands patients furious that I no longer take their insurance. The insurance companies know this and use it to their advantage.”

    Heh maybe you’re just trolling. Why are you concerned about angering those patients and not the hordes of other patients who are subsidizing the price discounts? Or why don’t you give the discount to everyone? It’s obviously still profitable or you wouldn’t accept it.

  31. kitty says:

    ” It seems that you have assumptions that everyone costs the same. One may say the burden is on me to show that they are different, I say that it’s for the other person to prove that they should be the same. It’s a stalemate.”
    I didn’t say that everyone costs the same; I told we don’t know if those with “unhealthy” life style cost more than those with “healthy” lifestyle. We also don’t know which specific lifestyle is associated with higher life-time costs. I also cited a study (Dutch) and an article in NEJM (a peer-reviewed reputable medical journal) in one of the past threads that contradict your view on the monetary value of prevention. The NEJM article reviewed all available evidence including the CDC evidence of the cost of diabetes and concluded that as a whole prevention doesn’t save money. So I do have some evidence. Now, who can better interpret the studies – a bunch of politicians who couldn’t read and understand an actual study if their life depended on it or doctors and epidemiologists writing for New England Journal of Medicine?

    “Cost of open heart surgery for the neighbor: $60,000+”
    But none of us is mortal. Everone dies at the end, and while some of both “healthy” and “unhealthy” die instantly in their sleep, many get sick at the end. 2/3 of women will eventually die of heart desease. Healthy lifestyle doesn’t entirely prevent the desease, it postpones some of them or replaces them with some other desease later in life. So the real question is what is more expensive an open heart surgery at the age of 50 (who may then die at 55) or open heart surgery at the age of 80 who may then die at 85. You may say that the person who needs open heart surgery at 50 ma live longer while sick, but the person who lives healthy lifestyle may be treated for “risk factors” before that, and years of prescription drugs and even recommended screenings and other tests add up as well.

  32. kitty says:

    Correction to the above: when I said “But none of us is mortal. ” I actually meant that all of us are mortal. We all die, and “healthy” lifestyle doesn’t really improve our chances for not requiring expensive end-of-life care, only increases the time before we require it.

  33. kitty says:

    The last post – promise (maybe). This is an interesting article from mythbusters on the subject of prevention of chronic deseases and healthcare costs. While not a scientific article, it pretty well outlines the complexities and confounding factors associated with cost of prevention itself:
    http://www.chsrf.ca/mythbusters/html/myth9_e.php

  34. Jon says:

    Kitty,

    I agree with you. We have to come to grips with our mortality if we are to have an affordable health care system.

    I still take issue with your presentation of these studies. They only report the *absolute cost* of health care, not the net cost or relative cost. For instance, obviously if an unhealthy person dies at age 10, they will cost very little compared to a healthy person who has a few minor surgeries over an 80 year lifetime. BUT which one contributed more to society economically? Obviously the person who lived long enough to have a good career and pay taxes. You never attempt to address that part of the issue.

  35. Lazy Man says:

    I think Jon has a very good point here. I would take it step further. There was a purposely absurd suggestion by on another part of this series, that we could really cut down the cost of health by giving everyone over the age of 10 a cyanide tablet. Of course people have health problems before age 10 sometimes, but we could just give them cyanide tablets at the first sign of sickness.

    This example shows that economically there’s some value to at least living until a certain age. As we become healthier, we are more able to be productive past our 70s. I think is an argument for healthier living so that we can continue to be productive as long as possible.

  36. kitty says:

    I agree that there is an argument for healthier living — all of us want to live longer; our loved ones want one to live longer and be healthier. Being healthy is its own reward. I do think though that most people overestimate the total effect of “healthy lifestyle”. It certainly has an effect, but with the exception of smoking and not being morbidly obese, it is a very small effect.

    But when you start talking about requiring the “unhealthy” to pay more of health insurance, you are talking about cost to others and this is where you get into a situation where there is some (maybe flawed) evidence that “unhealthy” cost less vs no evidence to the contrary. Also, dying at 10 is an extreme example. For the most part unhealthy lifestyle doesn’t cause one to die at 10, but maybe at 60 vs 70 or 70 vs 80. Some people are productive in their 70s, but most want to retire earlier if they can. So we aren’t really talking about most productive years of life.

    Additionally, it is extremely naive to think that healthier lifestyle will have any measurable effect on people’s productivity into their 70s. Getting older is the biggest risk factor for most conditions: heart desease, cancer, arthritis, osteoporosis (low weight is actually is risk factor). Some of these may be affected by lifestyle choice, most – aren’t. And even healthy people suffer from memory loss as well as loss of physical strength – so it is extremely naive to think that “healthier” lifestyle will have significant effect on productivity “past our 70s”. A small one – maybe, but not significant.

  37. M. says:

    Lazy Man, although you’re keeping hope alive for the fat tax, let’s look at some of the more nitty gritty issues.

    “The “fat tax” is not a tax on “fat” it is on unhealthy foods, however we currently define it. Right now we think that high-fructose corn syrup is unhealthy.”

    Who’s “we”? There’s a powerful lobby of corn farmers in the Midwest as well as several powerful national corporations who would beg to differ, I’m sure. And they have the cash to lobby Congress, who would have to pass such a law. I’m not saying that I disagree with you re: high fructose corn syrup, because I don’t. But government right now sure doesn’t feel like hfcs is “unhealthy”, despite “conventional wisdom” because it still sweetens our food supply.

    “Thus it would be taxed fairly highly and the savings would be passed onto to fruits and vegetables.”

    How so? Farm subsidies? Produce vouchers for low-income Americans? Putting Whole Foods in the ‘hood?

    “If five years from now high-fructose corn syrup becomes the healthiest thing in the world and fruits and vegetables become known as unhealthy, we reverse the tax and fruits get expensive while high-fructose corn syrup becomes cheap.”

    Time for a little civics lesson. Assuming a law was passed that created the “fat tax” that you propose, reversing the tax would require some federal agency to issue proposed regulations, provide a comment period, then finalize the regs. In most cases, that process taxes years. Yes, years. In the meantime, we could find out that Doritos contain antioxidants that could extend our lives for decades, yet Americans don’t eat them because they cost the same as a dinner at Pastis.

    “”When the fat tax does not work (taxing sin never has)” – I refer this Wikipedia reference, “It has been shown that higher prices for cigarettes discourage smoking. Every 10 percent increase in the price of cigarettes reduced youth smoking by about seven percent and overall cigarette consumption by about four percent.” Sounds like it would work.”

    My eating a plate of wings and fries around you doesn’t affect your health. My smoking cigarettes (if I smoked) does affect your health. There’s also a social stigma associated with smoking that doesn’t exist with “unhealthy foods.” If that was the case, then there wouldn’t be Super Bowl parties.

    And lastly, I have to admit that I find a heck of a lot of your reasoning on this issue to be quite smug. I commend you and your wife for managing your pre-existing conditions. But come on, you also have a substantially higher standard of living than a large percentage of Americans. I volunteer at a local food pantry, and it’s alarming to see the number of unemployed folks who I’ve talked with who never thought they’d have to resort to standing in line on a Saturday morning to get a small supply of groceries and had to choke down their pride to do so. I’m sure that some of them have pre-existing conditions, but trying to get by on a day-to-day basis is enough for them to handle. I also refer to my earlier point about the lack of fresh food in low-income neighborboods. In response, you wrote, “I’m not familiar with these places, but I have to figure that if we are collecting more money for bad food, we can make good food more available.” Again, who will be doing that? The government? Private industry getting government subsidies that likely won’t trickle down to the consumer level?

  38. Lazy Man says:

    Fat tax: I think corn would be fine because it’s used for ethanol ;-). I see what you are saying, but there would be some kind of mathematical formula, which will obviously not be perfect, but at least good enough to say that a Philly-cheese steak is less healthy than a banana. There will be fights over the formula, but there are fights over everything – eventually you get something close to fair or at least better than it as before the idea existed.

    Fruits and Vegetables: Sure how about farm subsidies. I don’t know how farm subsidies work, but it sounds good to me. I’m not an expert, but I could find experts. Maybe the government could pay each farmer more money for every apple produced. This is not an unsurmountable problem.

    Revising the Tax: It wouldn’t require a change in the law that would take years, just an update of “healthiness score” of the foods. If the system says that Doritos are twice as unhealthy as the average food, it’s tax falls in that 2x bucket. If we find that Doritos are twice as healthy as the average food, it’s tax falls in the 0.5x bucket. The law would apply to taxing of the buckets, and a Food/Health committee would review foods on a regular schedule. Law stays the same the classification of the food changes.

    “My eating a plate of wings and fries around you doesn’t affect your health.” No the physical location of you eating wings will not hurt me. However, I drive my car in Nebraska and it hurts the icebergs, penguins, and polar bears. It’s the same effect. The more healthy people, the less crowded hospitals are and the less busy doctors are. It’s not a direct effect like smoking or stabbing someone with a knife, but I don’t see how there is any doubt about the indirect effects.

    I’m sorry you found my response smug. I propose something that would make things better, and suddenly I’m expected to solve additional problems like getting healthy food to the poor in an undisclosed place that I’m not aware of. I can’t begin to speak about the logistics of that problem. I don’t live far from San Francisco which has a huge homeless population – yet I don’t see where it’s hard to find fresh food. You might just have to pay for it (which is what I’m proposing we change).

    Maybe this answer will be better. Yes, let’s let the government make healthier food available to the poor. Let’s fund that effort with the “fat tax.” When you are volunteering at a local food pantry, are you happy with the quality of food that you are making available? It sounds like you are not. The reason is likely that it’s very cheap food. If this cheap food was made more expensive, and the quality food was made cheaper, you’d be serving very cheap, quality food. This seems like good thing.

    I’m not trying to be smug, but I’m simply trying to solve a problem, the poor can typically only afford unhealthy foods, while middle class and rich can choose to pay extra for the healthy alternative.

  39. M. says:

    The reason that I raise the “nitty gritty” issues that I did was because considering the pull of special interests can’t be ignored. Take the Medicare drug benefit, for example. The drug industry, pharmacy benefit managers, and insurers bought and paid for that law. The result? Mass confusion for the elderly and disabled. To be sure, those on Medicare indeed have drug coverage. But no question, the other entities have benefitted from lining the pockets of members of Congress.

    “It wouldn’t require a change in the law that would take years, just an update of “healthiness score” of the foods.”
    Don’t forget that criteria would have to be established by law and regulation that would move at a snail’s pace. Additionally, the regulation of food in America is divided among federal agencies. For a frivolous yet true example, cheese pizza is overseen by the FDA, which is part of Health and Human Services. But pepperoni pizza is overseen by the USDA. Heck, nobody can agree on what the food pyramid should be, never mind what constitutes “unhealthy food.”

    By the way, you should also consider that we have enough of an eating disorder problem in this country, and it’s been proven that designating foods as “good” or “bad” in one’s mind doesn’t help matters. Imagine the effect of having the goverment mandate these labels.

    “When you are volunteering at a local food pantry, are you happy with the quality of food that you are making available? It sounds like you are not.” My point with saying that probably wasn’t as clear as I wanted it to be. What I was trying to say that keeping tabs on preexisting conditions are less of a concern to those folks because they have other things to deal with.

    Concerning the quality of food – I’m OK with it. The food pantry I volunteer at does provide clients with a bag of fresh vegetables, and the pantry foots the bill for these. The other food comes from the area food bank. The food bank obtains its food from donations that come from grocery stores. So yeah, they get what they get. But typically, clients receive canned vegetables, rice, pasta, cereal, peanut butter, tuna, etc. They also give out cake mixes and snack foods.

    “I don’t live far from San Francisco which has a huge homeless population – yet I don’t see where it’s hard to find fresh food.” The homeless aren’t shopping at Safeway. I’m talking about the urban poor and people who live in the projects. I would venture to guess that this is an issue in Oakland. In a few urban areas of the U.S., I’ve seen people shop for groceries at Walgreen’s because that’s all there is.

    “The more healthy people, the less crowded hospitals are and the less busy doctors are.” True, to some extent. Not all illness is caused or exacerbated by eating junk food. End-of-life care in America’s a huge expense, as is caring for individuals with psychiatric illnesses and Alzheimer’s.

    One other comment. I hated the movie “Supersize Me.” I rented it on dvd and shut it off after Spurlock force-fed himself a supersized extra-value meal and subsequently vomited. Force-feeding oneself anything until you puke, even vegetables, isn’t good for anyone. I felt that the movie lost credibility with that scene. But that movie’s been the symbol of “unhealthy foods” being the root of all evil. Consider the story of Soso Whaley, a New Hampshire woman who ate only at McDonald’s for a month (and did the experiment two more times) and dropped weight and lowered her cholesterol.
    http://www.nationalreview.com/interrogatory/whaley_200506230747.asp

  40. Lazy Man says:

    I realize that there are a few different food regulations here. My plan would hopefully fix that some way. I know the government hasn’t been successful, but that’s no reason to give up on it. Once you do that, what’s the alternative?

    Again the fact that people in Oakland may only have a choice of Walgreens is a topic completely separate from my plan. My plan wouldn’t make this situation worst, and it might even be able to make it better.

    I loved Supersize me. I’m skeptical of the article you listed since it just said that she had to have everything on the menu once. Well that can be done in first 7-10 days more than likely. From there on out she could have salads if she wanted to. She also could have meals that are completely atypical of the average customer – “My favorite meal? A medium chocolate shake with medium fries.” People typically have a drink, fries, and sandwich, the components of a value meal. I’m sure some have diet coke for the shake and get a sandwich (about the same calories), but others still get the sandwich and shake.

    It’s easy to eat healthy at many fast food places. However, there’s no escaping that the average Value Meal (what most people order) is more calories than most people should have for their 3-squares. I think Morgan Spurlock went with the average meal that people eat and I think she might have gone for lighter meals. I would love to compare the meals side by side. I’m sure Morgan Spurlock didn’t have fake doctors give him fake results.

  41. kitty says:

    “The more healthy people, the less crowded hospitals are and the less busy doctors are. ”
    Are you sure more people eating healthier would really have that dramamtic an effect? Have you checked hospital admission statistics to see what percentage of admissions could be traced to lifestyle? It must be available somewhere; I don’t have time to look, but it’d be interesting. I honestly don’t know what it’ll show.

    I do think you overestimate the impact of eating healthier. We know that being obese increases risk of some conditions but not nearly to the extent that smoking increases risk of lung cancer (and most people still don’t get lung cancer). What about two thin people – one eating more fat another more of the food you consider “healthy”? I mentioned WHI study that showed no difference in outcomes between low-fat group and the controls. Do you have any other study? Can you quantify the results e.g. per 1000 people and adjusted by age (most people gain weight when they are older) and genetics? All you have is your belief, but all the evidence so far shows pretty modest impact of lifestyle choices. Women still go to menopause at around 48-52 on the average, and once they do their risk of heart desease increases, their risk of osteoporosis increases, it becomes much more difficult to maintain weight, blood pressure and cholesterol go up more or less depending on genetics. No amount of healthy lifestyle can postpone the menopause as well as other results of aging.

    Additionally, as it was said above, you are only postponing some conditions, no eliminating them. In some cases you are replacing them with others. So we may see less diabetes, but more osteoporosis in women or prostate cancer in men. How would this reduce the total number of hospital admissions?

    I’d also like to second what M said about not trusting the government, insurance managers to know or understand the evidence and to quickly react when the evidence changes. Doctors cannot agree on the evidence – look at the recent discussions (post-ENHANCE trial) on value of LDL cholesterol measurement in many doctors blogs. How would you expect politicians to interpret this? Many current proposals for P4P emphazise blindly following the guidelines – e.g. achieve specific metric without regard for individual risk and variability or even conflict of interests in those who come up with the guidelines (e.g. are paid by pharmaceutical companies). Another example is Edwards’ plan to mandate annual physicals hoping that it’d reduce costs. This was happening after most medical journals and USPSTF concluded that annual physicals are useless for most people and that while some specific tests are recommended at specific age and specific intervals most annual physicals include not only non-recommended tests but also tests that USPSTF recommends Against because “harms likely to outweight the benefit” and waste a lot of money. So how can you trust the government and politicians to figure out what is right and to timely react to evidence changes when the doctors themselves don’t react that fast?

  42. kitty says:

    Talking about good timing. There is a post and discussion at a doctor and cardiologist’s blog about prevention and health care costs. In case you are interested in a cardiologist’s perspective on the true impact of prevention based on his experience and take on the studies, here is a link:
    http://drwes.blogspot.com/2008/02/when-it-comes-to-prevention-first-do-no.html

  43. M. says:

    “I realize that there are a few different food regulations here. My plan would hopefully fix that some way. I know the government hasn’t been successful, but that’s no reason to give up on it. Once you do that, what’s the alternative?”

    Yet again, Lazy Man, you are demonstrating how naive you are about legislative and regulatory processes. “A few different food regulations” doesn’t even begin to cover it. The cost to the Federal government for determining your fat tax would most likely outweigh the taxes reaped. I do think it’s great that you’re thinking outside of the box. But please, read up on how government agencies regulate and what it involves. The repeated retorts of “my plan will fix that” doesn’t adequately address the issues that many have raised.

    Additionally, we have no sort of Federal tax on retail goods in this country. The Department of the Treasury would have to set up an entirely new system to collect your fat tax. And where there’s dollars collected by the government, there’s also fraud. You’ll also need oversight to determine that the tax is being properly collected. If you want to get some sense of what implementing laws costs, read reports from the Congressional Budget Office.

    And just like prohibition, you are creating the best situation for food to be sold on the black market to circumvent the tax.

    “Again the fact that people in Oakland may only have a choice of Walgreens is a topic completely separate from my plan.”

    It is absolutely not. Many Americans lack access and means for high-quality healthy food. So it’s ethical to put these people more in the hole?

    “I loved Supersize me. I’m skeptical of the article you listed since it just said that she had to have everything on the menu once. ”

    I knew you did! Be equally skeptical of Spurlock. From a review of the movie posted here:
    http://www.glidemagazine.com/index.php?task=Articles&section=94&id=46548&issue=1
    “Spurlock eats by the rules of ordering everything on the McDonald’s menu at least once, and only super sizes upon being asked.”

    And as I mentioned, he forced himself to consume every bite of food that he ordered. Heck, if I force fed myself grilled chicken breasts to the gills at every meal for 30 days, I’d probably also mess up my health.

    And a couple of other points:

    * Kitty’s right about your overestimation of the impact that eating health really does have, as well as the impact of prevention. I lunched today with a friend who’s an executive with one of the biggest healthcare titans in the nation. To quote my friend, “Increasing preventive care is the worst cost containment strategy.”

    * Lastly, I seriously urge you to, offline, go and test out your theories about weight and “unhealthy foods” and illness. Do some volunteer work at a community health center or food bank. Talk to people battling MS or end-stage renal disease. Talk to people with costly mental illnesses or eating disorders exacerbated bt the notion of “good” food and “bad” food. Talk to physicians about what they see as the problems with the costs of our healthcare system. Visit a poor neighborhood and see how people live and where they buy their food. In other words, see how your theories stand up in the real world. I have done the things I mentioned in this paragraph, which shaped the points that I have made here.

  44. Lazy Man says:

    I’ve always said that I don’t know the ins-and-outs of the legislative process or regulatory process. I’ve spent my time in the technology field. I write about personal finance full-time now. I’m heavily invested in sports. That’s really the limit of the things that I have reasonable time to be an expert on. My idea is analogous to saying, “There should be an auction website.” Now it’s up for someone else to go invent Ebay. Just because someone doesn’t know how to code in Java doesn’t mean that their business idea wouldn’t work.

    It’s not the hardest thing in the world to tax products. We already do it with gas, alcohol, and cigarettes. Yes this is a little more complex, but it’s not like the entire wheel is being reinvented.

    It’s possible that my plan could be implemented at the state level. It might open up new problems and holes, but again that’s someone whose career it is to iron it out.

    Prohibition made alcohol completely illegal, not more expensive. Cigarettes are a good parallel. There’s a bit of a black market there. However, I think that 99.9% buy them legally and pay a huge tax over what their cost of production. The good far outweighs the bad.

    Oakland: You know why people don’t have access to healthy food… it’s because it’s currently too expensive. You open up a fruit store and charge $1 an apple and the cash-strapped person is going to take the nearly 400 calories of a double cheeseburger every time. The fruit store goes out of business – the economics currently in place don’t support it. If fruit is suddenly the thing that is cheap and the cheeseburger is expensive, Walgreens quickly adds an extensive fruit section. There’s no physical issue of getting produce to Oakland, plenty of it is grown just a few miles awhile.

    “And as I mentioned, he forced himself to consume every bite of food that he ordered. Heck, if I force fed myself grilled chicken breasts to the gills at every meal for 30 days, I’d probably also mess up my health.” That’s part the point of SuperSize Me. It’s not just that the food is unhealthy, but it’s also that the portion size is out of control (hence SuperSize). Did you see what the size of fries and soda were in the 70s vs. today.

    Of course a healthcare titan is going to say that increasing preventive care is the worst cost containment strategy. He’s absolutely right. If I go to the hospital everyday thinking I’ve got a new disease and want to be tested for it, costs are going to be crazy. I don’t suggest that. If that’s what the healthcare titan is seeing, he/she needs to address that separately from my plan.

    I invite your plan to go out and test my theories in the real world, but I don’t see what can become of it. At best, I’d get a few single points of data. It’s like watching one at bat of a baseball player, the sample size is too small. I have worked in a hospital (pharmacy technician) for years. I have talked to physicians about the problems they see in our health care system – they’ve got many more ideas to implement. I have not met one who said, “I wish there were a way to make people eat unhealthier. Everyone is consuming too many fruits and vegetables and showing up for check-ups at the perfect weight and in good health. It’s really going to be a huge burden for society.”

  45. Ron says:

    Lazy Man,

    Globally, black market cigarettes make up 11% of all cigarette purchases at a cost of 50 billion in lost revenue. (http://www.havocscope.com/trafficking/cigarettes.htm)

    Your plan would create multiple black markets. But that is not really the main point.

    I’ve noted that as this discussion has progressed your description of this issue has become more acerbic. You began by saying your reason for promoting this idea was to save healthy people 20% in insurance premiums. Your last comment indicates your desire to save our society from the “huge burden” unhealthy people place on them.

    I don’t know you but I would guess that in your estimation I’m unhealthy. And yet, I pose no burden on you. I work everyday, take care of my family and I’ve only been to a doctor, on average, once every 10 years if you exclude dentists and eye doctors.

    I’m 42 years old. My life, for all intents and purposes, is probably half over. Perhaps, if I’m lucky, I’ll get 10 more years and live to 94. So the question for me comes down to this. Can I have all the things that make life that much more gratifying to me, things that make my life just that much sweeter, as eating organically and exercising does for you? If my definition of a satisfying life is just as important to me as yours is to you, why do you get to decide that mine should be prohibited, in any way, by the government?

    If you will allow me to argue a point you haven’t made, please don’t compare what we are talking about to drug or alcohol abuse. I’m not an addict. I live in a free society where I’m allowed to be as healthy or unhealthy as I want to be within the physical parameters God gave me. Again, what we are talking about here are functional people who are simply living a lifestyle you don’t agree with.

    So, how about it? Why is my way of life subservient to yours?

  46. Lazy Man says:

    Well, 50 billion in lost revenue due to black market cigarettes is a lot, but it’s worth noting that 450 billion in revenue is created. I’d much rather make 450 billion and lose 50 billion then never have the 50 billion at all. (That number was worldwide too not US.)

    You may want to read the “huge burden” quote again. It was sarcasm of what a doctor would never say if people were healthy. It does not indicate that the unhealthy people place a huge burden on society.

    Ron, with all due respect, one example of yourself is not statistically relevant. You say that you pose no burden on me (and I’m not saying that I’m healthy either mind you), but that’s similar to one person saying that their SUV doesn’t impact global warming. Even if it doesn’t seem obvious, we know that it does.

    When you say that my life is subservient to mine it shows me that you don’t understand what I’m saying. I wouldn’t deny anyone of unhealthy food. I would just raise the prices so that those who want to eat healthy have that option. You would still be able to buy any food that you can buy today. The difference is that someone poorer would now have an option (subsidized by the unhealthy foods) to eat healthy foods that are currently unavailable to him/her.

    That’s what it’s about. It’s not denying anyone of their chosen lifestyle. It’s solving a problem where people often have to make a tough choice between their wallet and eating healthy.

  47. Ron says:

    Lazy Man,

    “You may want to read the “huge burden” quote again. It was sarcasm of what a doctor would never say if people were healthy.”

    I apologize. I did misread your quote.

    Still, I’m not being obtuse. I understand your plan perfectly. You are confusing disagreement and personal conviction with the ability to understand the concept you propose.

    You see fat people around you and conclude something must be done to make them healthier. Why? Well, the Good Samaritan in you believes if they lived as you do, eating organically and exercising moderately, they would ultimately be happier. You have also decided that another segment of our society, the poor, cannot sustain good health because they haven’t had access to the high-quality dietary foods you enjoy. Something must be done about that, too. But mainly, it is because you have decided that fat people are to blame for part of the ills associated with a broken health care system. They have caused an increase in your insurance premiums and become a burden to medical care givers. Unless something is done, it will only get worse.

    You are using theoretical evidence to adroitly draw conclusions that may only be superficially true based on nothing more than conventional thinking. It certainly isn’t based on science.

    Even with all the overweight unhealthy people that surround us, humans are living longer today than they ever have. Changing societal norms have influenced this but it has not been the driving force in any significant measure. Primarily, advances in medicine and health care have increased longevity. Additionally, human beings are not required to physically exert themselves from dawn to dusk simply to maintain a minimal existence as they did 120 years ago. We do not wear ourselves out merely to survive. This, too, has increased the life span of humans. You are also ignoring the fact that precepts for good health believed even 50 years ago are discounted as bunk today. Even the vaunted Food Pyramid is in its third rendition just in my lifetime. What does this mean? Perhaps what we are in is a natural ebb and flow of human existence. Perhaps there is no reason for you to step in and feed the poor apples and carrots. Perhaps I will live to ninety-four with minimal exercise and a high calorie diet. Perhaps you are simply allowing yourself to be manipulated.

    Your global warming comment is a perfect example. This is not proven science. Forty years ago the prevailing thought in the scientific community was another ice age was burgeoning. We cannot say with certainty that global warming is anything more than a natural cycle of warming and cooling. But I would bet you’ve altered the way you live significantly because of it. You are living in the moment. That’s fine. But you are also proposing that others live in your moment by extrapolating data that may be true today but could be looked on by future earth dwellers as quaint. Science is not something you’re supposed to “believe in”. It is supposed to be a simple stable empirical truth; a physical law drawn from years of experimentation and observation which produces the same result and is universally accepted. This doesn’t describe the climate change theory you embrace. It doesn’t describe your position about unhealthy people. You cannot say with certainty that you will live longer than most fat people and with a better quality of life than they will have.

    Finally, to state, as you and others have, that poor people cannot get fruits and vegetables gives the false impression that access alone would increase the odds they would consume them over unhealthy food. This is utter nonsense. In most cases, “being poor” is more a condition of “poor” lifestyle choices than it is a lack of funds. And I say that from personal experience. I don’t believe your plan will make the poor eat healthy foods anymore than I believe giving them a house will mean they will care for it in the same manner you and I do. (See Section 8 housing). Essentially, they will ignore your attempts at parental control and, forgive me, your rather self-righteous attitude about how they live, load their shopping carts with potato chips and beer and tell you to leave them alone.

  48. Lazy Man says:

    I don’t know where I came across as being healthy. I’m a bit overweight. I’m probably over the 25 BMI range. I don’t eat organically (it’s too expensive).

    I admit that these things aren’t proven sciences. I know that I can’t say with certainty that a health person live longer than an unhealthy person. People die in accidents every day. However, the odds do favor the healthy person.

    I think we have reason to take action before things are “proven sciences.” Even if you don’t agree that global warming is a problem, I haven’t found anyone saying that we should be hurting the environment more. If you are trying to build a successful sports team, do you throw up your hands and give up because it’s not a “proven science”? No you do the best the can with the information currently available to you. Five years from now, that information dictate that you should have done something different, but you are still better off using the information than doing nothing.

    Perhaps poor people will still load their carts with unhealthy options. Perhaps they’ll try healthier options when healthy foods are cheaper. In fact, I’m sure that some percentage of both would happen.

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