Jacob Sullum / Aug. 5, 2009

Fat Load

Lately, President Obama has begun calling his plan to reinvent America’s health care system “insurance reform.” Yet the version of the plan moving through the Senate also includes restaurant menu reform (a mandate requiring the conspicuous posting of calorie counts) as well as grocery reform, transportation reform and recreation reform (money to build farmers markets, bike paths, sidewalks and jungle gyms).

These provisions are all aimed at making Americans thinner, on the theory that doing so will reduce medical spending. It won’t. Even if it did, we should be wary of a political theory that says taxpayer-funded health care makes everyone’s personal habits everyone else’s business.

There are reasons to be skeptical that the anti-obesity provisions in the Affordable Health Choices Act will have a noticeable impact on Americans’ waistlines. The same research that nutritional nags cite in support of menu mandates indicates that even in restaurants like Subway, where the clientele is unusually diet-conscious, most consumers prefer to avoid calorie counts, enjoying their food in blissful ignorance.

To justify government funding for farmers markets, which would be supported by a $10-billion-a-year Prevention and Public Health Investment Fund, the Trust for America’s Health cites a survey in which 90 percent of visitors to two inner-city farmers markets in Michigan said they “wanted additional markets and had learned from the experience.” But the fact that people who go to farmers markets like farmers markets does not mean subsidizing them will change what Americans eat.

Still, let’s say the various anti-fat measures in the Senate bill work exactly as intended, improving diets, increasing exercise and reducing obesity rates. Surely that will save taxpayers money. After all, the U.S. Centers for Disease Control and Prevention says obesity-related health care costs something like $147 billion a year, accounting for about 9 percent of Medicare spending and 12 percent of Medicaid spending.

“The connection between rising rates of obesity and rising medical spending is undeniable,” the authors of the Health Affairs study cited by the CDC conclude. “Without a strong and sustained reduction in obesity prevalence, obesity will continue to impose major costs on the health system for the foreseeable future.”

Far be it from me to deny the undeniable, but the fact that obese people have higher annual health care costs, which is what this study found, does not mean they have higher lifetime costs. It therefore does not follow that reducing obesity would reduce total medical spending in the long run.

In fact, a study published last year in PLoS Medicine reached the opposite conclusion: Because obese people tend to die sooner than thin people do, the researchers found, eliminating obesity would increase spending on health care. “Although effective obesity prevention leads to a decrease in costs of obesity-related diseases,” the authors wrote, “this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.”

In a December report, the Congressional Budget Office likewise warned that “any savings to the federal government” from discouraging unhealthy habits such as overeating or smoking “could be at least partially offset by additional expenditures as healthier individuals live longer.” For example, “Medicare costs could rise for the treatment of other diseases and conditions during those extra years of life, and expenditures for programs that are not directly related to health (such as Social Security) could also increase as life spans are extended.”

Overeating, like smoking, seems to be one of those risky habits that saves taxpayers money. If reducing demands on the public treasury is the aim, such habits should be encouraged.

Or maybe we should question the idea that every citizen is a cost to be minimized for the greater good, without regard to his own wishes. The bigger the government’s role in health care, the stronger the rationale for such collectivist thinking.


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