Subsidizing a Healthier Nation

If you've been around long enough, you know I feel strongly about how bad America is about handling its waistline. My conservative readers are quick to remind me that we live in a free country with freedom of choice, that the citizenry always knows best how to manage their own life, and that government has no place in telling its citizens what to do.

And sure, that's a great theory, and true for a lot of things. Yet for weight control, I categorically disagree. Based on results—i.e., our shameful epidemic of obesity—Americans do not know how to manage their own weight. Yes, it's a free society and people are welcome to shoot themselves in the head if they really want to... just don't expect me to pay for the gun.

The problem with obesity is the suffocating health care costs which follow it. Obviously, obesity is not the singular cause for diabetes, but it is a disproportionately large factor in causing diabetes. If you smoke, eat high cholesterol foods, and are overweight... your chances of getting cancer, a heart attack, or diabetes goes off the charts. So these factors, together, are contributing causes to higher health costs. Which means taxpayers are subsidizing suicidal lifestyle choices by its citizens. When did this start becoming acceptable???

If you have private health care, and your poor lifestyle choices land you in the hospital with million dollar health care fees, game on—I have no problem with that. But the moment you ask me to start paying for your lung cancer operation because you smoked 2 packs a day for 30 years, or your quadruple bypass operation from a lifetime of eating red meat, or your stomach-stapling operation to manage your diabetes because you've been guzzling 40 oz. tubs of diet coke... yeah, shocker: I've got a huuuuuge problem with that. Conservatives who scream about lower government spending should be ahead of me in line about this injustice... yet they harp instead about "freedom of choice". Well, we tried freedom of choice for food and look where that got us—an obesity epidemic.

Nobody likes being told what to do. I don't think a government program telling people what to eat or when to work out would ever work. However, I do think circumstances can be shaped to give people sharper motivations to make better choices. My personal favorite has been a tax on fatty foods, the revenue of which would subsidize healthier foods: Big Macs get more expensive and healthy sandwiches get rock bottom cheap (that way the poor aren't punished because they can still eat cheaply, albeit better). Another option is giving tax credits to companies offering fitness programs to their employees—the payoff is a healthier and happier workforce who live longer (read: pay more taxes) and become more productive.

Still not convinced something like that would be financially viable? One company in Nebraska has been doing it for 16 years, and with impressive results. Their program sponsors a fitness program, including massages, pre-shift stretching, and quarterly checkups measuring weight, body fat, and flexibility. The prize is a 3 day company-paid trip to climb a 14,000 foot peak in Colorado. Of the 565 employees, 103 have qualified, more than ever before. Not only are the employees more fit, but the company pays about half the regional average in health-care costs, which is a savings of $2 million.

Morale of the story? It's cheaper to have healthier employees. Wow. What a concept. Imagine if we grafted that mindset onto an entire nation? How much money do you think we might save? More importantly, how much healthier, and how much happier, would we all be?

'Wellness' a healthy investment for company
LINCOLN, Nebraska (CNN) -- Lincoln Industries looks like a typical blue-collar plant -- workers cutting, bending, plating and polishing steel for products such as motorcycle tailpipes and truck exhausts amid the din of machinery.

But the 565-employee Nebraska company is different.

Lincoln Industries has three full-time employees devoted to "wellness," and offers on-site massages and pre-shift stretching.

Most unusual of all: The company requires all employees to undergo quarterly checkups measuring weight, body fat and flexibility. It also conducts annual blood, vision and hearing tests.

"When you get the encouragement from somebody to help you with nutrition and to help with a more active lifestyle, it makes it easier to be able to attain a lifestyle that most people want to attain anyway," says Hank Orme, president of Lincoln Industries.

The program has been in place 16 years.

The company ranks workers on their fitness, from platinum, gold and silver down to "non-medal." To achieve platinum, they must reach fitness goals and be nonsmokers -- and the company offers smoking cessation classes.

For employees, reaching platinum means a three-day, company-paid trip each summer to climb a 14,000-foot peak in Colorado. This year, 103 qualified, the most ever. And 70 made the climb.

For the company, the payoff is significantly lower health-care costs. The company pays less than $4,000 per employee, about half the regional average and a savings of more than $2 million. That makes the $400,000 Lincoln Industries spends each year on wellness a bargain.

"The return on investment is extraordinary," Orme says.

The investment in "wellness" pays other dividends, according to Orme. He says fitter workers are more productive, have better morale and are safer. As evidence, he points to worker's compensation claims. Ongoing safety training and an increasingly fit workforce have pushed worker's comp costs down from $500,000 five years ago to less than $10,000 so far this year.

Seven years ago, shift leader Howard Tegtmeier was in the non-medal category. The 49-year-old smoked, drank, was overweight and took 12 pills a day to treat high blood pressure, high cholesterol and diabetes.

"I just made the decision it was time to change my life, and the wellness program showed me ways to do that," Tegtmeier says.

Tegtmeier says he no longer smokes or drinks. His weight is down from 230 to 180, thanks to diet and exercise. His cholesterol and blood pressure are also down, and he says he no longer needs medication.

Tonya Vyhlidal, Wellness and Life Enhancement director, says Lincoln Industries doesn't pressure workers who don't want to participate. But sooner or later, she says, the company's "culture" attracts most employees to live healthier lives.

The company sponsors races, helps with gym memberships or exercise equipment, offers healthy choices in the vending machines and hosts classes on health and nutrition.

"There's a way to engage everyone. Even those that are really resistant," Vyhlidal says, adding that she'll offer employees suggestions based on what makes them feel fulfilled: "Do you like to ride a bike? Ride a bike. Do you like to cook? You may need a different cookbook."

This month, Tegtmeier and 69 co-workers climbed Mount Bierstadt, a 14,060-foot mountain. All of them reached the summit. It was Tegtmeier's fourth climb with the company.

"The view up here is wonderful," he said. Link.

More Evidence for a Fat Tax

The Brits have a social healthcare system, and a recent study has concluded that individuals can no longer be held completely responsible for the British obesity epidemic and the government must now take a more pro-active role.

Well, amen, brutha.

I can already hear how the ensuing conversations will play out:

You wouldn't let someone commit suicide, right? But overeating isn't suicide.

Obesity-related illnesses shorten your lifespan. But that's a personal choice.

Yes, but the poor have neither the money nor ideal living conditions to set themselves up to eat well—they are handicapped from the start. So they're just victims?

In part. But it's really the government which has a moral responsibility to protect to the public health, which means stopping a flu outbreak, monitoring cattle for mad cow disease, or curbing a national obesity epidemic. Sometimes that means standing in the way of massive corporations making a kajillion dollars. I know, I know—that's unpopular, uncapitalist, un... American? Maybe. Irresponsible? Definitely not.

Look, you misunderstand. I do not want fatty foods outlawed—that'll never be the answer. Just slap a fat tax on fatty foods, make them expensive enough to dissuade people from gorging on them too often (why not charge $8 for a whopper rather than $4?), and use the resulting tax revenues to exclusively subsidize healthy foods. (Or at least offer tax credits to healthy food restaurants.) The poor don't suffer, and the nation gets healthier. Yes, it impinges freedom of choice, but not all freedom of choice is good; if you think so, then don't cry to me when your grown child swallows a shotgun.

Don't take my word for it. Take the word of 250 experts:

Obesity 'not individuals' fault'

It is said we live in an 'obesogenic' environment
Individuals can no longer be held responsible for obesity so government must act to stop Britain "sleepwalking" into a crisis, a report has concluded.

The largest ever UK study into obesity, backed by government and compiled by 250 experts, said excess weight was now the norm in our "obesogenic" society.

Dramatic and comprehensive action was required to stop the majority of us becoming obese by 2050, they said.

But the authors admitted proof that any anti-obesity policy works "was scant".

Nonetheless every level of society, from individual to the upper echelons of government, must become involved in the campaign against a condition which carries such great social and economic consequences, they said.

In 2002, those who were overweight or obese cost nearly £7bn in treatment and state benefits and in indirect costs such as loss of earnings and reduced productivity.

In 40 years time, that figure could reach nearly £46bn, as health services struggle to cope with the ill health such as diabetes, cancer and stroke which can be associated with excess weight.

"There is a danger that the moment to act radically and dramatically will be missed," said Sir David King, the government's chief scientific advisor and head of the Foresight Programme which drew up the report.

"It is a problem that is getting worse every year."

So hard

Obesity, the authors concluded, was an inevitable consequence of a society in which energy-dense, cheap foods, labour-saving devices, motorised transport and sedentary work were rife.

In this environment it was surprising that anyone was able to remain thin, Dr Susan Jebb of the Medical Research Council said, and so the notion of obesity simply being a product of personal over-indulgence had to be abandoned for good.

"The stress has been on the individual choosing a healthier lifestyle, but that simply isn't enough," she said.

From planning our towns to encourage more physical activity to placing more pressure on mothers to breast feed - believed to slow down infant weight gain - the report highlighted a range of policy options without making any concrete recommendations.

Industry was already working to put healthier products on the shelf, the report noted, while work was advanced in transforming the very make-up of food so it was digested more slowly and proved satisfying for longer.

But it was clear that government needed to involve itself, as on this occasion, the market was failing to do the job, Sir David said.

Shock tactics?

Public Health Minister Dawn Primarolo said the government would be holding further consultations to decide how to proceed.

She said it was too early to say whether the same "shock" approach seen in public health warnings against smoking would be adopted with obesity, or whether a tax on fatty foods, highlighted in the report but widely dismissed as unworkable, would be considered.

"The most important thing is there has to be public consent and understanding of the issues you're trying to challenge," she said.

"A mandate for change will be difficult because it has to be preceded by an understanding of the dangers of obesity."

The Royal College of Physicians said the report was "encouraging".

"The emphasis on cross-governmental initiatives is particularly welcome, as is the importance of addressing issues across society whilst avoiding blame," said its president, Professor Ian Gilmore.

The Food and Drink Federation said it understood its role in tackling the problem.

"Our industry is now widely recognised as leading the world when it comes to reformulating products; extending consumer choice; and introducing improved nutrition labelling," a spokesperson said.—Source

America Needs a Fat Tax, part 2

Occasionally, Chris ads a witty comment to my blog, but on my America Needs a Fat Tax post, he pulled out the stops. My reply was so long that I wanted to repost it, but it made no sense without his comment:

Sorry it's taken me so long to respond; life has been pretty interesting lately! Anyway, here goes:
First, the costs of obesity to the health care system have been vastly overstated, largely by groups who support various social engineering schemes. Those costs that do exist could be cut by reducing the heroic end-of-life care that most Americans receive. The last couple of weeks of life are more expensive than all the years that came before.
Second, the reason that these health care costs may indirectly affect you as a taxpayer is precisely because of the social policy interventions that you're advocating, particularly blanket mandates for insurance coverage. If insurance companies were allowed to offer consumers actual choices, then these costs could be adequately priced in. For example, at my employer, there is a surcharge for health plan participants who are overweight.
Most importantly, due to inefficient tort laws, health care insurance is one of the largest components of the rise in health care costs over the last twenty years.
The infringement of personal liberty that you refer to is not due to people doing what they choose with their own bodies. The infringement comes from the state deciding that I should have to pay for their choices. Further coercion doesn't fix this just as two wrongs don't make a right.
To continue with the outcome-based portion of the argument, it's useful to remember that these kinds of social "fixes" only lead to more problems -- the Law of Unintended Consequences. A problem we're avoiding talking about now in the Social Security system (by the way -- WTF? -- "nobody ever complains" about the Social Security system? C'mon). A better analogy would have been the tobacco industry...
Another point to consider is that a fat tax would almost certainly amount to a regressive tax on the poor. The relatively wealthy people shopping at Trader Joe's probably wouldn't pay much at all, while the day laborers, truck drivers, and fast food workers themselves who eat fast food at lunch would pay the most. It seems a little callous to demand that the poorest and least educated people should pay an ignorance tax, but since the state does the same thing with tobacco I suppose it's not an entirely inconsistent position. At least the lottery they run gives you a choice to not play.
Anyway, leaving costs aside as you tried to do (but came right back to in the very next paragraph of your response), even if the outcome-based arguments were against me I would still be against your proposal. The government's job is not to maximize the public's health, but to maximize liberty.
I find it ironic that the person who was the subject of your original post is decidedly NOT obese, and hence not a part of the "problem", and yet she would be obligated to pay your fat tax for her indulgence along with the porkers you are targeting. How is this tax in any way fair to her or the other millions of people who don't eat too much?
If you want to "encourage" people to lead healthier lives, I can think of many non-coercive ways to do so. To demand it from them by using the force of the state is the very definition of the nanny state. It is right of you to recognize that fast food is bad for your body and, if eaten to excess, will make you fat; that is exercising your reason. And it is right that you rant about it on your blog and encourage others to see the truth you've discovered. That is exercising your liberty. But using the state to coerce virtue takes the exercise of reason and liberty away from those you're coercing, whether you want to make them eat better, follow the teachings of the Holy Book, or enslave them to build the Worker's Paradise. The point is that you are not persuading people or educating them or removing obstacles for them to change themselves. You are forcing them, with the power of the state, to follow your dictates instead of using their own reason. That's what I'm against.

As ever, Chris, you take this all to a whole new level. Awesome.

While I concede some of your points, allow me to rebut:

1) End of life measures are one size fits all—gastric bypass surgery is only for those who can't put a fork down. End of life measures have almost nothing to do with willpower: we all deserve a shot at getting a few more hours on the planet if we can. (The exception to end of life care is a liver transplant recipient who starts smoking again—they shouldn't get another liver transplant.) What people choose to do with their bodies should influence (to some degree) the level of care they receive. This is why overstating the costs of obesity-related illnesses is moot. And besides, my doctor wife would say the costs are substantial, basely simply on the patients she sees every day.

2) I would agree that the tort laws need reforming. Not big news, but significant.

3) I don't think I ever said my personal liberty was being infringed upon because of other people's choices, but because of the costs I must pay because of those choices. If you take money out of your own pocket, I don't really care. If you take money out of my pocket (when it can be avoided), that pisses me off.

As for unintended consequences, I know full well that a fat tax might substantially cripple the fast food market, at least temporarily, which would have a global economic impact. The problem is that until someone says different, fast food companies are primarily in business to make money, not to make Americans healthy, which is a fundamental flaw in the system, in my opinion. Of course, consumers should choose whatever they want—it is their choice, after all—but that approach has left America in the grips of an obesity epidemic. At some point, you have to ask yourself if it's a good thing to make PCP or heroin legal—allowing consumers total freedom of choice is not always a good idea and the government does have some responsibility to step in and nudge people in a certain direction, if only for their own good. Lest we forget, longer living taxpayers are longer paying taxpayers. Denmark, for example, has outlawed all trans-fats, and Danes undoubtedly live longer lives as a consequence.

I used the Social Security system as an example to show how the government can play a beneficial role in improving national welfare even though it means money forcibly taken out of one's paycheck, the closest allusion to "forcing preferences on people at the butt of a gun". However, nobody complains about social security because everyone admits it's in the best interests of the nation, just as (I think) a fat tax would be.

A fat tax would surely have many unintended consequences, but I'll gladly take that new set of problems over our current set of problems because what we're currently doing is no longer working.

4) I don't buy the "taxing the poor and ignorant" argument, and never will. People have to eat something and when revenues from a fax tax subsidize healthier foods, healthier eating habits will emerge. In an ideal world, fast food chains would instantly wise up and make healthier fast food. If day laborers have a choice between a Subway $4 turkey sandwich at and a McDonald's $5 Bacon Double All-Beef Cheeseburger, which lunch will these blue collar souls choose? They'll make better eating choices and live longer with fewer health problems—how is this a bad thing? And if Subway's non-fatty sandwich were also subsidized by fat tax revenue, then that $4 turkey sandwich will become $2, which nerfs the financial burden that "taxes" the poor and ignorant. Problem solved.

Perhaps unsurprisingly, I'm a strong supporter of California's cigarette tax. Normally, I'm not fond of the government legislating personal liberties, but the California's cigarette tax revenue subsidizes anti-smoking campaigns (are they still doing that? No idea.), which rests squarely within the government's mandate to safeguard the public from the health hazards of second-hand smoke. Higher prices for cigarettes means fewer smokers, which is an intrinsically good thing, in my opinion. Higher prices for fast food means fewer fast food eaters. As long as fast food is so unspeakably unhealthy, expensive fast food is also an intrinsically good thing.

As for the "government's responsibility is not to maximize health, but to maximize liberty", here we must agree to disagree. I've lived in France and though their economy sucks ass, nobody can afford to eat expensive fast food all the time. Europe leans more towards maximizing health over liberty and they live healthier lives because of it. It is time to emulate that model.

And yes, anyone who eats fast food is subject to paying the fat tax, porkers or not. You wouldn't offer first time smokers their first pack for free, would you? A fat tax would act as blanket fee discouraging recidivists and first-time users equally.

Finally, the crux of the argument: reason vs. coercion. While true that many non-coercive ways can encourage people to lead healthier lives, America is still in the middle of an obesity epidemic. When do we admit our current actions have not gotten results? Besides, what reasonable person would smoke two packs a day knowing that it would probably kill them by an ugly disease? What reasonable person would intentionally gain 300-500 pounds? Many people, while sometimes reasonable about their actions in a detached and abstract way, do not show reasonable behavior in their daily lives (myself included!). Quite the contrary, they might admit they know what they're doing is wrong, but have no palpable disincentive to stop. A fat tax is that clear barrier to bad habits because when you have to choose between paying rent and eating fast food 50 times a month @ $10/sitting, you start to reevaluate your lifestyle choices.

People are going to do what they want to do. A bill to charge a fat tax will probably never get passed because fast food lobbyists will browbeat any attempt to pass it, or not enough Americans will support it. And that is true choice—America will decide for itself whether or not they need a fat tax to help them "kick the habit". Until then, the undereducated and unmotivated will continue their self-destructive behaviors unchecked. If a nation of blimps with a crippled health care system is truly the result of freedom of choice, then I hope it get gastric bypass surgery within my lifetime.

To read all this, you'd think I'm a gung ho socialist, I bet. In many areas, like when France bullies Apple to change their iTunes business model, I feel market-driven decisions are infinitely better than government interference. However, laissez faire economics does have its limits when it comes to public health and freedom of choice does not extend to letting people ingest arsenic on a daily basis. We know, as we knew with nicotine, that fast food causes health problems... so why aren't we doing anything to stop it?

In the meantime, I enjoy hearing dissenting views if only because it gets people talking about the issue.

Thanks, Chris!

America needs a Fat Tax

After reading Kristen's blog today, I couldn't help but repost my reply to it; the topic is simply too important.

Our country is out of control, eating itself into oblivion, cutting physical education classes, offering sub-standard school lunches. It's embarrassing. I mean, seriously.

About ten years ago, I got a ticket for running a red light—on my bicycle. I remember pleading to the cop's sense of the absurd: "Come on, man... I'm on a bicycle. Do you think I really need a ticket for this?"

He smiled. "I'll tell you the same thing a cop told me when he caught me speeding years ago—the only way I know you'll change your behavior is if I hit you in the pocketbook." That was a $275 lesson and I've never run a red light on my bike again. Lesson learned.

Anyone can learn new behavior if the stick is painful enough. If there's a tastier carrot, even better, but the stick has to hurt, too.

We need to make fat food unpopular. We need to make it expensive. I know that might have massive implications for the fast food industry and my response can be summed up in two words:

Sod off!

KFC, McDonald's, Taco Bell... all you guys can blow me. You're giving Americans loaded guns and saying we're pulling the trigger ourselves. Okay, I'll give you that... so let's price the guns at $1000 instead of $100 and see how that affects the equation.

My idea is a fat tax. I explained it in Kristen's blog today:

The pendulum has reached its apogee for our adoration of fat food and the trend is ever so slowly coming back. It may take a generation of people getting diabetes and gastric bypass before we start to realize that our health care system carries the greatest financial burden of bad dieting, which means we all pay for everyone's bad choices.

My wife thinks I'm crazy, but I have the solution to this fast food mess—a fat tax.

Here's my theory: you tax the restaurants for using all the stuff that makes people fat, like all the saturated fats. The more customers buy the food, the more tax they pay. The goal of a fat tax is to make fast food expensive and unpopular... and then use that new tax revenue to subsidize healthy food alternatives which are more expensive than fast food. That eliminates the "but you're taxing the poor" argument because you'd be driving poor people to buy a 99¢ smoked turkey sandwich on wheat, rather than a chewy fat pill like a double-bacon cheeseburger.

Of course, a fat tax would be incredibly unfair for big businesses and their profit margins, but you have to ask yourself when enough fat American is enough; government is meant to represent the people's interests—NOT big business' interests—and (sadly) the only way the average citizen permanently modifies their behavior is when it hits them in the pocketbook.