The Star Beacon; Ashtabula, Ohio

World, nation, state

January 27, 2013

Do penalties for smokers and the obese make sense?

NEW YORK — 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:

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

n 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.

n 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.

1
Text Only
World, nation, state
  • Deep-sea octopus goes without food for 4.5 years while watching eggs

    Talk about extreme parenting: Scientists have found a deep-sea octopus mama that faithfully guards the same clutch of eggs for an incredible 4 1/2 years — a record.

    July 31, 2014

  • Study finds 35 percent in U.S. facing debt collectors

    More than 35 percent of Americans have debts and unpaid bills that have been reported to collection agencies, according to a study released Tuesday by the Urban Institute.

    July 30, 2014

  • U.S. blasts Israel for Kerry criticism

    The Obama administration pushed back strongly Monday at a torrent of Israeli criticism over Secretary of State John Kerry’s latest bid to secure a cease-fire with Hamas, accusing some in Israel of launching a “misinformation campaign” against the top American diplomat.

    July 29, 2014

  • Outlook on Medicare finances improves

    Medicare’s finances are looking brighter, the government said Monday. The program’s giant hospital trust fund won’t be exhausted until 2030 — four years later than last year’s estimate.

    July 29, 2014

  • Plan to simplify 2015 health renewals may backfire

    If you have health insurance on your job, you probably don’t give much thought to each year’s renewal. But make the same assumption in one of the new health law plans, and it could lead to costly surprises.

    July 28, 2014

  • Hospital shooting suspect charged with murder

    A man accused of fatally shooting his caseworker and grazing his psychiatrist at a suburban Philadelphia hospital complex before the doctor returned fire has been charged with murder.

    July 28, 2014

  • Man seeks video of Oklahoma City bombing

    One man’s quest to explain his brother’s mysterious jail cell death 19 years ago has rekindled long-dormant questions about whether others were involved in the 1995 Oklahoma City bombing.

    July 28, 2014

  • Bill in Congress to help veterans with PTSD

    A group of lawmakers have joined together to help veterans with Post Traumatic Stress Disorder (PTSD), Post Traumatic Brain Injury (PTBI) and other war injuries get speedy medical treatment — and avoid Veteran’s Administration bureaucracy and Department of Defense lack of accountability.

    July 28, 2014

  • U.S.: Russia has fired rockets into Ukraine

    Stepping up pressure on Moscow, the U.S. on Sunday released satellite images it says show that rockets have been fired from Russia into neighboring eastern Ukraine and that heavy artillery for separatists also has crossed the border.

    July 28, 2014

  • U.S. says Russia is firing across border into Ukraine

    Russia is launching artillery attacks from its soil on Ukrainian troops and preparing to move heavier weaponry across the border, the U.S. and Ukraine charged Friday in what appeared to be an ominous escalation of the crisis.

    July 25, 2014

House Ads
Parade
Magazine

Click HERE to read all your Parade favorites including Hollywood Wire, Celebrity interviews and photo galleries, Food recipes and cooking tips, Games and lots more.
AP Video