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Do penalties for smokers and the obese make sense?

Posted by on Jan. 26, 2013 at 6:54 PM
  • 8 Replies

Saturday January 26, 2013 10:15 AM


The Associated Press

NEW YORK (AP) - Faced with the high cost of caring for smokers and overeaters, experts say society must grapple with a blunt question: Instead of trying to penalize them and change their ways, why not just let these health sinners die?

Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures.

But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers' estimates.

And attempts to curb smoking and unhealthy eating frequently lead to backlash: Witness the current legal tussle over New York City's first-of-its-kind limits on the size of sugary beverages and the vicious fight last year in California over a ballot proposal to add a $1-per-pack cigarette tax, which was ultimately defeated.

"This is my life. I should be able to do what I want," said Sebastian Lopez, a college student from Queens, speaking last September when the New York City Board of Health approved the soda size rules.

Critics also contend that tobacco- and calorie-control measures place a disproportionately heavy burden on poor people. That's because they:

-Smoke more than the rich, and have higher obesity rates.

-Have less money so sales taxes hit them harder. One study last year found poor, nicotine-dependent smokers in New York - a state with very high cigarette taxes - spent as much as a quarter of their entire income on smokes.

-Are less likely to have a car to shop elsewhere if the corner bodega or convenience store stops stocking their vices.

Critics call these approaches unfair, and believe they have only a marginal effect. "Ultimately these things are weak tea," said Dr. Scott Gottlieb, a physician and fellow at the right-of-center think tank, the American Enterprise Institute.

Gottlieb's view is debatable. There are plenty of public health researchers that can show smoking control measures have brought down smoking rates and who will argue that smoking taxes are not regressive so long as money is earmarked for programs that help poor people quit smoking.

And debate they will. There always seems to be a fight whenever this kind of public health legislation comes up. And it's a fight that can go in all sorts of directions. For example, some studies even suggest that because smokers and obese people die sooner, they may actually cost society less than healthy people who live much longer and develop chronic conditions like Alzheimer's disease.

So let's return to the original question: Why provoke a backlash? If 1 in 5 U.S. adults smoke, and 1 in 3 are obese, why not just get off their backs and let them go on with their (probably shortened) lives?

Because it's not just about them, say some health economists, bioethicists and public health researchers.

"Your freedom is likely to be someone else's harm," said Daniel Callahan, senior research scholar at a bioethics think-tank, the Hastings Center.

Smoking has the most obvious impact. Studies have increasingly shown harm to nonsmokers who are unlucky enough to work or live around heavy smokers. And several studies have shown heart attacks and asthma attack rates fell in counties or cities that adopted big smoking bans.

"When you ban smoking in public places, you're protecting everyone's health, including and especially the nonsmoker," said S. Jay Olshansky, a professor at the University of Illinois-Chicago's School of Public Health.

It can be harder to make the same argument about soda-size restrictions or other legislative attempts to discourage excessive calorie consumption, Olshansky added.

"When you eat yourself to death, you're pretty much just harming yourself," he said.

But that viewpoint doesn't factor in the burden to everyone else of paying for the diabetes care, heart surgeries and other medical expenses incurred by obese people, noted John Cawley, a health economist at Cornell University.

"If I'm obese, the health care costs are not totally borne by me. They're borne by other people in my health insurance plan and - when I'm older - by Medicare," Cawley said.

From an economist's perspective, there would be less reason to grouse about unhealthy behaviors by smokers, obese people, motorcycle riders who eschew helmets and other health sinners if they agreed to pay the financial price for their choices.

That's the rationale for a provision in the Affordable Care Act - "Obamacare" to its detractors - that starting next year allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums. A 60-year-old could wind up paying nearly $5,100 on top of premiums.

The new law doesn't allow insurers to charge more for people who are overweight, however.

It's tricky to play the insurance game with overweight people, because science is still sorting things out. While obesity is clearly linked with serious health problems and early death, the evidence is not as clear about people who are just overweight.

That said, public health officials shouldn't shy away from tough anti-obesity efforts, said Callahan, the bioethicist. Callahan caused a public stir this week with a paper that called for a more aggressive public health campaign that tries to shame and stigmatize overeaters the way past public health campaigns have shamed and stigmatized smokers.

National obesity rates are essentially static, and public health campaigns that gently try to educate people about the benefits of exercise and healthy eating just aren't working, Callahan argued. We need to get obese people to change their behavior. If they are angry or hurt by it, so be it, he said.

"Emotions are what really count in this world," he said.

by on Jan. 26, 2013 at 6:54 PM
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Replies (1-8):
by Jamie on Jan. 26, 2013 at 7:12 PM
1 mom liked this

well shit its not always because you are eating bad that you are overweight

I had three children and a tubal and the tubal hit me hard.

i eat less than i used to and i am active and i am still a little overweight

by on Jan. 26, 2013 at 7:24 PM
My sister is a smoker and I am obese. I am not a over eater and never been I eat 1000 cal a day and excersize daily. I been losing weight slowly but I always been on the bigger end. So why would I be punished for? Im not doing anything wrong. Not even the doctor can tell me why I am fat. he say it's generic. Well that's something to punish right? when its comes to smokers and alcoholics I feel that those items should be removed from the stores. anything that can be a poison long term or short term should not be let on the shelf of the stores. including unhealthy fatty foods and sugar. they should make healthy food more affordable. if you notice healthy food is considerably more expensive then junk foods. but they want to make that money from cigarette and fast food and alcoholics. imagen if those things would not be available to the public. The amount of money tobacco companies and fast food joints loose and liquor stores? Not to mantion the drug companies that manufacture the drugs and sell in a premium price to treat those illnesses that cigarette alcohol and fatty sugary food cause. So I have a hard time believing that those people really senser about solving the health problems. they still want to make to money from sales but not willing to fix the problems they caused. I know we all have our rights to eat what ever we want in moderation but if we know that a item will make the populations sick why put it on the shelves.?
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by on Jan. 26, 2013 at 7:27 PM
Yes so I assume they just gonna let us get folks die nomatter what the cause. Its crazy

Quoting silverdawn99:

well shit its not always because you are eating bad that you are overweight

I had three children and a tubal and the tubal hit me hard.

i eat less than i used to and i am active and i am still a little overweight

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by on Jan. 26, 2013 at 7:43 PM

 What about the crackheads, methfaces and alcoholics oh and heroin addicts why fix them why do they get to have methadone why are we putting them in rehab let them die. These people do not drain our health care system, with overdoses and crackbabies and  heroin addicted babies or any baby addicted? Instead of pointing at just the smokers and obese I think there is worse things. And yes I got a big ass! But I don't smoke but I use to which is why my ass is bigger.

by on Jan. 26, 2013 at 8:05 PM

This article harshly assumes that weight is the fault of the person for poor eating habits and completely overlooks side effects of medications and surgical procedures. Smokers on the other hand, yes, they should pay for that habit if they want to keep it. However, quiting aides need to be more available

by on Jan. 26, 2013 at 8:40 PM

Smoking and being obese are CHOICES.  Yes if you make unhealthy choices you should be charged more.  Can it be harder for someone to lose weight than others?  Ayep, but the person who can do nothing about their weight is extremely rare.  Life isn't fair.  Some people are naturally thin, some people have to work at it.

I have to work at it, hard, everyday.

People's insurance rates can go up for things they cannot control.  My husband has had asthma since the age of two, our life insurance is higher as a result.  He never had a choice to have asthma or not.

So yes, absolutley people should be charged more for their unhealthy choices.

by Member on Jan. 26, 2013 at 8:46 PM

NC already does this for all state employees, but they implemented it over time, several years, to allow people time to lose the weight and quit smoking.  If you don't smoke and are within a healthy weight zone (and by this they mean not morbidly obsese) they cover 90% of your health costs, if you smoke/are overweight, they only pay for 80%.  It's used as a motivator for people and because those are two big leading contributors to expensive medical problems.  I've heard of some companies doing this too, and offering rewards for losing weight/quitting smoking. In the long run, if it motivates people, it's a good idea.

by on Jan. 26, 2013 at 8:47 PM
1 mom liked this

Only if they are going to fine the people who can't afford their own health insurance, and pregnant women

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