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Healthcare: Paying for It

While my brilliant plan is certainly the only possible way to go (he said with a wink), there will apparently be some form of significant government sponsored healthcare reform or coverage passed in the relatively near future. No matter what plan is chosen, it will be expensive.

Those who choose an unhealthy lifestyle should pay for this. Rather than taking away choices, we should tax those things that are voluntary and universally recognized as unhealthy for everyone.

The tax should begin relatively small and should be set to automatically rise gradually but increasingly over 10 years to a point where the tax causes the bad stuff to be nearly prohibitively expensive. This should be made very clear so that all Americans have 10 years to develop a healthy diet or go broke. By gradually increasing the tax over time people will change their behavior at about the same rate. As a result, the tax should remain about the same as the stubborn pay for their unhealthy lifestyles to the bitter end, and fund the system.

If the government is going to pay for healthcare, then we should do our part. The problem is that we want our double cheeseburgers with Super-sized fries and a chocolate shake. This plan will not eliminate these options. Over ten years it will just make a “Value-Meal” cost $50 instead of $5.

So what are those things that everyone knows are bad for you?

Tobacco
Calories

That’s it. No one can argue that fewer of these two things will make us healthier and thus reduce health care costs.

Taxing “Calories” allows us to cover all the bad stuff you would otherwise target on its own: Alcohol, sugar, white flour, red meat. Over ten years the producers of these products will develop lower calorie versions that taste great.
• Beer will all be “light” and we will all be used to it.
• Hard liquor will become lower proof (80 to 60 to 40) with better ingredients to retain the taste. Fewer drunks would also reduce healthcare costs.
• Bison will gradually replace some cattle and beef will be leaner.
• We will eat more chicken and fish and maybe Ostrich.
• We already have many versions of substitute 0 calorie sweeteners.
• All soda will become “diet” soda and there will be no such thing as “regular” soda. Zero calorie soda will have no tax.
• Restaurants will serve smaller and healthier portions. Fettuccini Alfredo will either leave menus or be made with lighter milk because the restaurant will be hard pressed to afford the calorie tax on heavy cream.
The key is that it will take ten years. We will adjust gradually. We are innovators. We, the poor, middle class and eventually even the wealthy, will all learn to eat better, providers will sell smaller portions, and food producers will learn to make healthier food. We will adapt and innovate and be able to afford healthcare.

Tobacco: This is easy. Tax it at every stage of production. Seeds to cigarettes. Start with the significant taxes we impose now and gradually raise them over 10 years until a pack of cigarettes is $50 in today’s money. Each year 10% of smokers will quit or not start due to cost alone. In ten years, there will be no remaining tobacco products to purchase. Rehab will be the cheaper alternative.

Calories: This at least seems more difficult, but it really is’nt.
The tax would occur at the point where the US distributor sells to the US retailer, whether the retailer is a restaurant or a grocery store or a farmer’s market. The US distributor may grow the products or purchase the products domestically or overseas. Where they get them is not relevant.

Establishing the tax is also not difficult.
• We already rate meat based on how lean it is. The distributor can reduce his tax by trimming it closely. There is probably a simple way to do this that scientists understand.
• Produce is pretty easy. Broccoli has a pretty standard number of calories per ounce.
• Anything in a box has the calorie count right on the side panel.
• Sugary cereals, candy, ice cream, etc will go the Splenda route or become very expensive. Pure perfect ice cream will still exist for really special occasions.

In the beginning the tax will be relatively low. Twice each year it will go up a few percentage points for ten years. It should accelerate as the ten years nears its end. At the end of ten years it will level off at a rate that will seriously dissuade Americans from eating too many calories.

The only exception would be baby food for those under three years old. Babies need calories. Adults do not like baby food, so I doubt this will create a calorie abuse problem.

Combine this with cultural changes we are already working on. Eat less. Exercise. But every medical practitioner will tell you that you lose weight by eating fewer calories, not by exercise, though it helps.

For my five step plan, go to http://lipspeak.blogspot.com/

By the way, I am overweight and eat too much. I hate this plan . . . but it is still the right one.

  • DaGoat
    Too many holes in this for to list them all but to name a few:

    You are right infants and toddlers generally should not be calorie restricted, but since most babies are eating mostly table foods by one year your baby food exemption would not be adequate to ensure they will get adequate calories.

    Moderate alcohol intake is at least neutral and possibly beneficial to overall health.

    Many other groups should not be calorie-restricted, including many elderly, people on chemo, people with severe emphysema, people who are malnourished for various reasons, etc, etc.

    The concept of taxing food will hit the poor disproportionately and will be a very tough sell.
  • jwest
    How about we legislate that everyone needs to wear a helmet and body pads, just so they will be less prone to hurt themselves if they fall down?

    Brilliant Ned, just brilliant.

    Do you have any idea of how much money it would cost society to have people healthier than today? I realize you’re trying to save money, but that’s not what this plan does.

    The biggest problem with healthcare spending is end-of-life extraordinary measures being performed when the remaining quality of life doesn’t justify the cost. Living longer also places a burden on the Social Security system, which is going broke as it is.

    Rich people tend to be thinner, healthier and of course have access to the best healthcare. They also have the means to support their lifestyle and add to the overall economy while aging. The poor are more prone to be obese, which reduces lifespan, generates relatively sudden deaths and eases the monetary burden on the segment of society that is not a net consumer (rather than contributor) of social services (public money).

    If you force people to be healthier overall, the minor savings you will achieve in short term medical costs will be more than offset by the higher expenditures on these same people later in life, along with other costs (Social Security, etc.) that would not have been paid out if the person had died early.

    Everyone dies Ned. It just makes sense that those who cost society more die sooner than those who contribute. This may sound a bit harsh, but it’s reality.
  • jchem
    I suppose Ned if you are OK with all of these taxes you wouldn't mind increasing the tax on gasoline as well? Why, in 10 years we could pay $50/gallon. Not only will this discourage excessive driving, it will also be good for the environment. It would even have the added benefit of forcing people to walk more, which may just make them healthier. Try selling that to anyone out there.
  • Yeah, much as I'd like to see people eat better, exercise more and generally care for themselves better, I don't see this as very realistic. Just on a practical level, how would you keep me from having a burger, no fries at McDonalds, some fries at Wendy's and a milkshake at Burger King? Or I could order the fries and shake for my baby.

    Sin tax, such as tobacco tax is already in place and rising.

    To jwest's predictably cold comment, get used to it, buddy. Every generation lives about 50% longer than they think they will. It's not a matter of us doing something to make this happen. It will happen anyway, so better we plan for it than pretend health nuts or 'end of life' procedures are causing it. Had to laugh at your 'rich people' are thinner line. Your party has presided over a 30 year stagnation of income for middle income and lower Americans, while the already rich got richer.
  • Ned, I think there are many problems with your proposal, but the most important one is that there is far from a consensus that calories are bad for you. In fact, I'd say it's the opposite. Everyone knows we need calories to survive. It's not the calories that are bad. It's eating too many calories that is bad. And more important, what is "too many" differs from person to person. Your plan would actually punish active people since they need to eat more calories in order to maintain their active lifestyle. Additionally, whenever we implement any sort of incentive or disincentive program, we have to be very careful because if not done right, people will figure out how to get around your program and not achieve the results you wanted. For example, I imagine eventually McDonald's could come up with a 50 calorie big mac that tastes decent, if given enough time and resources. However, something tells me even that would not qualify as health food, given the highly processed artificial chemicals that it would probably take to create such a thing in some lab. Many health professionals are not fond of diet soda, despite the fact that it is 0 calories, because there is some concern of the sweetener that is used. So if we implemented your policy, we might be trading one problem for another see we would be over-emphasizing the importance of a low-calorie diet above all else.

    However, I do think your general point is correct. The fairest way to pay for our healthcare system is to make those who make poor health choices pay more. In an ideal world, when a person makes a choice that increases their likelihood of needing more healthcare, they should pay more proportional to the extra risk they are taking on. This is one of the main problems I have with universal health care in which everyone pays the same amount, since it means no one is financially responsible for their own poor health decisions. However, I'm usually the first to point out that many health problems are not predictable or preventable. That's why I advocate this approach:

    Currently, our health care system punishes those who are sick, whether they are sick because of poor choices, or whether they are just unlucky. This is a failure of the free market system (how well the free market works in any particular case is proportional to how strong the relationship between choices and results is). However, we can fix this by keeping the free market system, but regulating it such that it punishes people for the *choices* they make, not their health status. So I don't entirely disagree with you that we need to find a way to create an incentive for making good healthcare choices. This is very difficult for the government to do, since pretty much the only tools they can use are taxes or banning certain choices. We'd likely get a system that is either too simplistic, such as a tax on calories, or else a mish-mash of compromises that is unproductive, since it would be very difficult to get the government to agree on what choices are good and bad, and how good and bad they are.

    Ironically, it is the free market that is best equipped to create such an incentive system. They are already in the business of judging someone's risk of needing health care based on their current condition and lifestyle. The only change would be that health insurance providers would need to be regulated such that they would only be able to use peoples *choices* to determine what to charge for insurance, and not current health condition. For example, a smoker with lung cancer would get charged the same amount as a smoker without lung cancer. The health insurance companies would be allowed to ask only behavior questions, such as "do you ride a motorcycle?" Of course you could have people lying, but if someone gets in a motorcycle accident who had told the company they would never ride a motorcyle, the company would be off the hook, and the patient would be responsible for his health care costs, so there is no incentive to lie.

    But alas, the premise of your post is that we have a government-run health care system, so my solution is probably off topic.
  • kathykattenburg
    What everyone else has said, and I'll add some questions:

    The only exception would be baby food for those under three years old. Babies need calories. Adults do not like baby food, so I doubt this will create a calorie abuse problem.

    Really? What about pregnant women and nursing mothers? They don't need calories? For that matter, what about children over three? Children over three don't need calories? Diet Coke is no healthier than regular Coke. It contributes to osteoporosis in older women. Not that that's going to stop me drinking it; I'm addicted to the stuff. But I'd rather make that decision myself than have the government tell me it doesn't matter if my bones snap. And what about orange juice? Great for you, loaded with Vitamin C... Terrible for you, loaded with sugar.

    I could go on. Your plan is impractical at best and extremely foolish at worst, for lots of reasons. In general, I'm opposed to the school of thought that believes punishing people for the choices they make is better than addressing the varied and complicated reasons people make the choices they do.
  • TT
    We don't have to take choices away but we could level the playing field a bit if we could stop the incessant marketing of bad health choices to people via tv/radio/media and in the food stores in particular. The rapidly shrinking produce section is a real concern.

    We could market healthy choices instead. No nasty tax disincentives to administrate
    We could encourage local neighborhood businesses like fruit and veg shops, butchers, bakers, SMALL grocery stores with some raw ingredients and not so much processed/packaged foods (Trans fats anyone?). Shops that are close enough to walk to (exercise). Instead of marketing/selling pepsi and coke we could sell the idea of kitchen gardens and small farms and living and eating locally. This might also encourage people to slow down and to stop multi-processing (good for mental health as well). While we're at it how about some local cafe's as well? With real chefs cooking real food and *not* brought in from some food industrial complex in handy portion controlled packaging to be warmed up by the staff... This would also provide useful employment and business ownership and people that have a vested interest in the people and the community.

    The possibilities are endless (and healthy)! :)


    We shouldn't penalize people for being swayed by the marketing machines that assault us everyday that encourage unhealthy choices and lifestyles.

    We could even re-employ the marketing people that currently work for Coca-cola/Pepsi/McDonalds/Heinz/etc since they've done such a good job with their current employers.
    :)
  • joeinhell
    Deal with reality. We don't have to worry about the cost. We've got Bernie Maddoff. Give him a day off for every hundred million he raises, he will have the health care paid off in three or four months. People "give" him money.
    I'd bet on Madoff before the treasury secretary or the head of the fed. Bernie fucks up, he goes to prison, that other pair of clowns take Pearl Harbor as a bonus and totally fuck it up. I'd bet on Bernie
  • aabacot ,

    How do you recommend we implement your strategy? Do we pass laws forbidding companies that make unhealthy choices to advertise? I don't see that as any better than Ned's proposal, and it means an endless political debate about which choices and bad and how bad. The result would be a mish-mash of over-simplified policies that won't get it right even most of the time.

    As a side note, your comment reminded me of a TV documentary I once watched where they put a banana and a cupcake in front of a child and allowed them to choose. Of course they always chose the cupcake. Until they plastered stickers of cartoon characters all over the banana. Then they chose the banana. Since then I've always wondered by health food companies don't do more to market their foods to kids. If you look at any produce section, or any health food packaging, it's always extremely boring to kids. But I don't think this is a question of government policy, just marketing strategy of private companies.
  • Don Quijote
    How do you recommend we implement your strategy? Do we pass laws forbidding companies that make unhealthy choices to advertise?


    Step 1. We kill Over the air broadcast TV.
    Step 2. We Kill Cable TV.
    Step 3. We create a market in which people can buy TV programming by the show.

    Easy Problem solved.
  • TT
    Since you asked :)...

    among other things we could:
    implement laws that severely restrict marketing to children period.
    restrict marketing in certain areas the same way that cigs/alcohol have restrictions on marketing
    and/or
    We could out-market the companies who are currently encouraging bad lifestyle choices
    also
    Local planning councils could permit/encourage/demand walking neighborhoods with neighborhood shops/parks/cafes/etc., rather than clumping the shops/etc into strip malls that have to be driven to and from.
    To me the local councils are a key player - and whoever licenses shops. That's where small businesses get stymied.

    It's a complex issue isn't it?

    Personally we got rid of the TV about 3 years ago - life's too short and I don't like the influence on the small children...
  • Something tells me getting rid of TV is not going to cause McDonald's to go out of business. I think their marketers are smart enough to find other ways to attract a large number of customers.

    I'd be in favor of a ban on marketing to children if I had some confidence in it being able to be enforced, but that is difficult (it's difficult to prove it was marketed to children?). Besides, most of the problem is that *adults* made bad decisions, including decisions on behalf of their children.

    Restricting certain markets from doing business would be even more difficult, since it would be hard to get a consensus on which activities are bad and how bad. We're bordering on social engineering here.

    So, yes, we could do all that. Or, we could just have people pay the full cost of the decisions they make, and let people decide for themselves. To me, that options seems easier to implement and more reliable. If the government is not in the business of subsidizing health care in the first place, there would be no problem with how to pay for it. (please see my first comment for details on my proposal in which people pay based on the risk associated with the behaviors they choose--and the risk is determined by private insurance companies).
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