The Dietary Nanny Patrol is at it again, this time with an article in the current New England Journal of Medicine claiming that a penny-per-ounce tax on sugary soft drinks would help to reduce the nation’s bulging waistline while raising $150 billion “that governments can use for health programs” over the next decade. And cows nationwide will breathe a sigh of relief over the plunging demand for belt leather. This is another in a long line of similar ideas to paste a bull’s-eye on isolated food groups as a way to refill depleted tax coffers under the guise of public health advocacy.  It always seems odd to me that the estimates of enhanced tax revenues and increased public health are so often trumpeted together, even though the achievement of one always comes as a tradeoff against the other. Such “solutions” send mixed messages and are inefficient as hell.

Diffuse incentives to control what people do and don’t consume are not the solution to obesity. And we don’t need yet more paternalistic academics, politicians, and bureaucrats telling us how to live our lives. I may not agree with some folks’ choices to eat, smoke, and drink themselves to extinction, but I’ll defend to the death (i.e., theirs) the sovereign right to do so, as long as I don’t have to subsidize those behaviors.  And please don’t go hitting me with drive-by taxes for my own harmless consumption of the occasional burger, fries, and Coke.

The real tipoff that this is just another government money grab is that the taxes collected won’t even be remotely used to pay for obesity-related medical costs. If you don’t believe me, ponder this. Of the scores of billions of dollars from the 1998 tobacco settlement, less than 10% has been spent on smoking prevention and practically nothing for treating smoking-related illnesses.

If the goal is for people to accept direct financial responsibility for their inappropriate actions, there’s a much fairer and far more effective way to do it: allow health insurers to charge higher premiums to people who drive up their own medical risks and costs with behaviors like smoking, overeating, under exercising, and abusing alcohol.  Right now, 75% of your health insurance premiums are going to pay for the preventable diseases caused by these and other self-destructive behaviors, both of omission and commission.  So if obese people incur 40% higher medical costs each year than their more slender fellow citizens, let them pay 40% higher health insurance premiums. Not only will this end current subsidies of the fat by the slender, it will also present an inherently fair choice to the obese: you can pay the higher premiums and continue to overindulge to your heart’s short-lived content, or you can lose the excess and pay much lower premiums—and, incidentally, live longer, earn more, and spend more time with your grandchildren.

The problem with ideas like taxing soft drinks is that they start from a muddled concept of the goals their proponents want to achieve. Is it to cut obesity rates? To find new tax revenues? To fund public health efforts? Or to assign personal responsibility for unhealthy outcomes of ill-advised behaviors? Otherwise smart people, like the authors of the NEJM article, too often start with a solution before fully considering what it should accomplish. That’s pretty dumb.

This entry was posted in Health Costs, Health Insurance, Health Reform Goals, Prevention, The Health Care Crisis and tagged , , , , . Bookmark the permalink.

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