By Larry Marsh, Kansas City Star Midwest Voices columnist 2009
Congress has failed to get at a root cause of our rising health insurance costs. We must confront obesity and unhealthful eating to save lives and cut cost.
If your home got hit by a tornado, no one would tell you you should have done more to prevent it. Our health problems are not that simple.
They break down into three types: Type One are unlikely problems you don’t anticipate. Type Two are problems you expect but can’t do much about. Type Three are problems you could have prevented or greatly reduced the probability of.
Everyone agrees we should pay for insurance for Type One problems. Most people agree with paying for Type Two. But why should we all have to pay for Type Three?
Some people take wild and reckless chances with their health. They expose themselves to all sorts of dangers, eat lots of unhealthful things and avoid exercise.
To make matters worse, once covered by health insurance, they do even more unhealthful things. This last bit is what economists call the “moral hazard” of insurance. Moral hazard simply means that you increase the risky behavior you are insured for just because you have insurance.
A basic principle of economics is that you pay for what you get. The costs are directly associated with the corresponding benefits. In principle insurance deviates from this only in the sense that the premium you pay should be directly associated with the expected benefit.
If your house is more expensive to replace, or you live in a more tornado-prone area, you can expect to pay a higher premium.
Health insurance follows this same basic principle for problems under Type One, which are essentially just bad luck. For Type Two the problems can be foreseen but are uncontrollable, such as a woman with a gene that puts her at high risk for breast cancer.
Here many of us would agree to redistribute the costs of this type of misfortune. It’s not her fault. She was born that way. Give her a break.
The real issue is with Type Three. These people could have prevented or at least reduced the probability of health problems. But they didn’t. Worse yet, many of them increased their unhealthful behavior, taking advantage of the rest of us and making us pay.
This moral hazard problem violates the principle that you pay for what you get. It is a key source of our rising, out-of-control health care costs.
This has nothing to do with some nanny state trying to tell you how to live your life. We don’t care if you want to smoke like a fiend, drink yourself into a stupor and eat Ho-Hos and Ding-Dongs like there’s no tomorrow. (Actually some of us do care, but that’s not the point.) We just don’t want to pay for your unhealthful behavior.
Conservatives (not to mention liberals) have to face the fact that someone has to pay if we are going to have health insurance (either public or private). If the word “taxes” is too upsetting, just call it a “premium adjustment.”
We need to call upon a panel of medical experts to construct a list of unhealthy foods. There could be several categories from extremely bad to just plain bad. We need to apply the “premium adjustment” (aka federal sales tax) to these foods and other unhealthy consumables.
It may not be feasible to determine how much exercise you’re getting or how recklessly you drive your car, but we certainly can do something about all the bad food people eat, which is driving up our health care costs.
Now is the time to impose a federal sales tax on unhealthful food. To compensate the poor and reduce calories, food stamps should count double when purchasing unprocessed fruits and vegetables.
Congress must pass a health insurance law that gets at this root cause of rising health costs.
Larry Marsh of Kansas City is professor emeritus at the University of Notre Dame, where he taught economics for 30 years. He served as director of Notre Dame’s Ph.D. program in economics for 13 years. To reach him, send e-mail to or write to Editorial Page, The Star, 1729 Grand Blvd., Kansas City. Mo. 64108
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Also see:
We need to move beyond a one-size-fits-all health care system
The incentive structure of our health care system is all wrong
To some libertarians even private health insurance is a bad idea
Obama fails to fully address perverse fee-for-service incentive system
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Make people pay extra for their bad health habits
The problem with your theory is that everyone fits into the third category. Folks like to harp on and bring focus onto the obese population because we are, of course, the most clearly seen. But you, and everyone reading this reply has sat down and consumed food way past your filling needs. Have eaten unhealthy foods and haven’t usually bothered to go right out and exercise after wards. But because you are possibly blessed with a regulated metabolism that burns the extra calories, you want to point fingers at those of us who have metabolism that don’t work as well. Stop being hypocrites by attempting to call us out on the exact same thing you do. Instead of being critical of, and attempting to punish the obese population wouldn’t a better and even healthier course of action be to invest funding into finding out why our metabolisms are so extremely different. In finding out what additives are being placed in our foods that may be playing a part in the vast growing of Americans. We eat and exercise no differently than the majority of the rest of you, please stop trying to make it seem as if there is this huge difference. An added tax on unhealthy foods would not be a obese population's tax, but everyone’s.
Laurie Todd
Executive Director
StaytheCourse Plus Size Community
www.staytc.com
Good Idea Larry....
I will vote for this if it covers stopping libs from doing anything which raise my blood pressure, which of course can be bad for my health.
I would categorize this as type 3, since the libs obviously know what they are doing, and they do it deliberately, thereby raising the risk of my becoming ill.
Let's attack libs' ideas as the first item of category 3 healthcare reform....
chairman of the bored
Recently, we’ve had the healthcare national buzz, conversation of sorts, shouting matches and many words here. We have debated the healthcare industry as if it was an idea when all along it has been and will continue to be a business, an industry with a huge market-share, private companies, publicly traded, robustly insured…
We nibbled on the financial industry a while…tried to count the tax dollar numbers headed that way…that was a blur
Learned a bit about automobile companies and saw national treasure go there…a new line of responsible finless chevies…
Now, the healthcare sector…wow, what a huge web…stakeholders, those with no hope, big profits, complex insurance models…
And throughout this time we’ve been pumping heavy dollars into defense…contracts, sustainment, improvements, and bonuses for service members (even officers!)…big market share in this field.
Yet I sense we’ve come to a bit of a crescendo…folks a bit weary of all this imaginary political debate…
…when all along…it’s really been about business…not politics…
We didn’t elect a President…we elected a Chairman of the Board (bored?)
Tom Ryan
The Crossroads
The truth always comes out
Larry has, unintentionally I’m sure, given credence to what many believe when it comes to this plan; this isn’t really about health care, but rather about control.
Once the government controls your health care it can control every aspect of your life using exactly the reasoning Larry uses in his piece.
They’ll be able to tell you what you can eat, what you can and cannot do for recreation and how you live in general. Theoretically they could limit the number of kids you have or perhaps not allow you to have children at all if there is evidence that you carry genetic traits that could result in a child that would require extra and expensive health care.
Those of you who support socialized medicine; have you really thought about what you might be giving up? Do you really want to open the door to the possibility of the government having control over all aspects of your life?
Surely something could be devised that would get affordable care to the millions of American citizens who don’t have insurance without blowing up the entire system. That is, if covering the uninsured is really the goal.
Ross Balano Midwest Voices 2008
but who gets to be the
but who gets to be the authority on what are "bad habits?"
So suppose you have a fit, muscular, young guy who is single, in college and he works out 6 times a week. Yet he is a smoker, drinks heavily and eats crap...so where does this person fit?
WHat if you have the person who is 400 lbs and eats actually fairly well and trys to exercise and has perfectly normal blood pressure, etc.
Or how about the guy who runs 5 miles a day, eats right, lives healthy but has a 600 cholesterol, etc...
when you open the pandora's box for penalizing bad habits you, well open pandoras box. Then you have the bureaucracy of the government or someone determining whether you fit into 97 different categories of "health" and we are in the same boat we are in now.
The answer is ala carte insurance shopping. Instead of the government forcing insurance companies to provide giant, all encompassing policies...let the young single, guy who doesnt smoke or drink have a basic healthcare policy that doesnt need to cover psychiatric services, maternity and addiction counseling.
Trying to shove round pegs in triangle holes with a bulldozer is not going to solve our problems.