You can disagree with the doctor ”” you can even be offended ”” and still come to see that there is a larger point behind his tough-love approach. The debate over health care reform has so far revolved around how insurers, drug companies, doctors, nurses and government technocrats might be persuaded to change their behavior. And for the sake of the economy and the federal budget, they do need to change their behavior. But there has been far less discussion about how the rest of us might also change our behavior. It’s as if we have little responsibility for our own health. We instead outsource it to something called the health care system.
The promise of that system is undeniably alluring: whatever your ailment, a pill or a procedure will fix it. Yet the promise hasn’t been kept. For all the miracles that modern medicine really does perform, it is not the primary determinant of most people’s health. J. Michael McGinnis, a senior scholar at the Institute of Medicine, has estimated that only 10 percent of early deaths are the result of substandard medical care. About 20 percent stem from social and physical environments, and 30 percent from genetics. The biggest contributor, at 40 percent, is behavior.
Today, the great American public-health problem is indeed obesity. The statistics have become rote, but consider that people in their 50s are about 20 pounds heavier on average than 50-somethings were in the late 1970s. As a convenient point of reference, a typical car tire weighs 20 pounds.
Of course the NYT is pro-tax on obesity, but their real mission comes in this little kernal about the costs that obese people thrust onto the healtcare system, “A natural response to this cost would be to say that the people imposing it on society should be required to pay it” And thus the arguement for the tax and the ability to nanny people on what they eat, how much they exercise, etc.
You can use the same logic for people who ride motorcycles, climb mountains, surf, parachute from airplanes and on and on.
So, it’s okay for government to tax people for all these things because of the costs they supposedly impose on the system. But isn’t this what private insurance companies try to do to set healthcare policy premiums? Oh, but that is bad, its immoral, it’s devilish, it leads to profits, etc.
The difference is that letting private insurance companies do this gets government out of everyone’s business. And that’s why the liberals hate it!
Overweight and obese people are only a burden on others insofar as others are compelled to support them via taxation. In short, this isn’t a problem of obesity, it’s a problem of socialism.
There’s something a bit creepy about the government profitting when people choose wrongly but something DOES have to be done to get people to take responsibility. Doctors seem to shy away from weight discussions or, if they do mention it, present it in such watered-down terms that the patients can easily dismiss it. I know this from discussions with people in my life who are morbidly obese.
I have Systemic Lupus Erythematosus. I have a network of friends with autoimmune diseases (mostly Rheumatoid Arthritis) and several are extremely overweight. I’m afraid that I tune out a bit when these ladies complain about how much their knees hurt. I have gently and carefully encouraged them to lose some weight so they’d feel better but their backs go up. They say their docs have casually suggested weight loss, but in the same breath with offering pills and injections to keep the pain at bay so it’s easy for them to dismiss it. Why do the work if no one is going to hold you accountable and a jab every couple of months will ease the pain?
Another gal is my housekeeper/provider. She would have to lose over 100 pounds just to be within shouting distance of normal range AND she’s diabetic because of it all. When she assists me with my weekly shopping, I don’t have a problem if she shops for her family at the same time but I am shocked by all of the junk she piles up in her cart. (And it’s all purchased with food stamps.) I try to steer her toward the fruits, vegetables, and lean meats that I’m buying (I’ve even tried to GIVE her packs of veggies that I’ve bought in buy one, get one sales) but her response is either “ewwwww” or “yuck!” Sigh…
Of course, both of these women have families. The husbands are as large as they are and the kids are growing up with these eating habits. It’s cyclical. Both ladies also admit to varying degrees of depression, largely untreated.
Have you noticed lately, too, how many morbidly obese people have handicapped placards and utilize the battery-powered carts the stores provide for the disabled? The enormity of the problem, pun intended, is best seen at Walmart. I haven’t seen it as much at grocery stores where I usually shop. But, at Walmart, it is very difficult for a person with a disabling disease such as mine to find an open handicapped space or a motorized cart to use in the store. And when you enter the store and see who is using them, the majority of the time it’s the people whose primary difficulty is obesity. There was actually a letter to the editor in our local paper about this very issue and lots of concurring responses, so I’m not the only one noticing it.
In a rather bizarre “Seinfeld-esque” moment last weekend, my son and his girlfriend took me to Walmart for some necessary items and we could find neither a handicapped space or a cart. My son’s girlfriend then saw two very obese people sitting on the motorized carts, waiting for their husbands to go to the handicapped spaces and pull the car up. She decided to take pictures of it on her camera phone, in a burst of moral outrage, with the intent of complaining to the management. I told her to let it go. There’s nothing the management could do, anyway. And I told her we would simply confine our shopping to one small section of the store to get the prescriptions we needed and go elsewhere for the other things. Walmart is simply too big for a disabled person to shop the entire store without assistance.
Something really does have to be done. We’re all paying the price for the obesity epidemic.
[blockquote]We’re all paying the price for the obesity epidemic. [/blockquote]
Any how/why is that?
Calvinism is not dead. It just morphed into high moralistic socialism.
Another new diet—–TAXES. I sincerely believe that many of the poeple who write articles about obese people are thin people who rarely have to worry about weight loss of more than 5-20 pounds at any given time in their lives. They believe, in a somewhat prejudiced and usually unstudied manner that obese people simply lack will power or are weak. Many obese people that I have shared with have tried 5 to 10+ different diet programs with more discipline and willpower than any natually thin person would ever conceive. They have lost much of their weight…only to put it on again plus some. This is a humiliating experience and leads to all sorts of circular behavior including even more self-hatred. Ask a thin person who detests fat people their level of dislike of obese people and you’ll get between a 5 and an 8. Ask an obese people how much they dislike themselves for being obese….and more often than not you’ll get a solid 10.
I have come to the conclusion that after losing 112 lbs., 127 lbs, and 97 lbs. at three different times in my life, that diets simply do not work in the long-term for many obese people. If diets worked long-term wouldn’t there be, like Aspirin, one or two diets that worked really well that most everyone would follow? This rather than 1,000+ diet books on the market with a new one coming out each week? In my experience, diets all follow a simple pattern. By eliminating or severely restricting items from your diet, your body will, for a time, lose weight. An obese person may lost weight quickly at first, but then the rate at which they lose weight will start to slow. Eventually, they stop losing weight altogether and their psyche, which has been deprived for a long while, says, “Fill ‘er up!” And the weight comes back on. Obesity issues are much more complex than a lack of will power of personal discipline. I speak from 45 years of experience as an overweight person, with 10+ diet programs under my belt…literally, 25 years in full-time/ successful church ministry, and post-graduate degrees. I am not lazy or undisciplined…I am obese. Taxing me more will not solve the issue….oh, if only it would!
Jeffersonian,
Insurance premiums in the workplace are often based on usage and demographics. Obese employees have a high incidence of diabetes, heart problems and accidents on the job. This affects the rates for everyone.
Food stamps are a government program so tax money is being used for those junk and convenience foods. It shouldn’t be. Families are getting fat and children, especially, are learning bad eating habits on the government’s tab. The problem becomes cyclical.
On a personal note, when obese people are utilizing the customer services intended for disabled people, we who are truly disabled cannot shop or, if we have no choice but to shop, must risk falling and/or being in a lot of pain later. That’s simply not right. I cannot walk without assistance and I cannot walk far without pain. Obese people NEED to walk and using services for the disabled simply makes their problem worse.
[blockquote]Insurance premiums in the workplace are often based on usage and demographics. Obese employees have a high incidence of diabetes, heart problems and accidents on the job. This affects the rates for everyone.[/blockquote]
I see your point, but why do so many of us get our health insurance through employers when we don’t get life, homeowner’s, auto or other insurance that way, thus exposing us to this pernicious mechanism? Why don’t health insurance companies charge higher premiums for these clients?
Mulitiple studies from all around the world over many years all come to the same conclusion. “Over weight” people and even “obese” people live YEARS longer than “ideal weight” people and even many years longer than “under weight” people.
Japanese, Finnish, Canadian, and American studies:
http://www.physorg.com/news164519566.html
http://www.timesonline.co.uk/tol/news/uk/article537571.ece
http://www.theregister.co.uk/2009/06/24/overweight_live_longer/
http://www.nzherald.co.nz/world/news/article.cfm?c_id=2&objectid=10121660
See for yourself. Do the research. Then ask yourself…should the government be taxing folks for being overweight when that factor is likely to indicate that they will live YEARS longer than the allegedly “ideal” or “healthy” weight people? Should we tax a survival trait?
Should we start taxing “under weight” people?
teatime, I agree entirely that food stamps should be usable for a range of reasonably healthy foods rather than junk food. I think that the computerized store barcoding and checkout systems would easily accommodate marking certain foods available for food stamp purchase and some not.
As to taxing the obese, this is nonsense. The causes and cures for obesity are fairly complex, and it is the obese person who pays the price in terms of shortened life span. The argument that reducing obesity would reduce health spending across the years and the total population is false, actually. Obese people die younger on average, and thus have fewer years of claims. Losing the weight and keeping it off, if possible, would be of great benefit to the individual, but in terms of macro demographics, it simply means they drop out of the health care system sooner, with problems in their forties and fifties which other people experience a couple of decades later.
And then there are always exceptions like my grandparents. One of them smoked heavily for 60 years and died at 93; the other was quite fat for most of her adult life and likewise lived to 93. You never can tell.
Seems to be quite a contrast between my #10 and #9. Really, I don’t know, except that the obese do have more diabetes. But these disagreements highlight the futility of taxing the overweight.
#6 Mark Williams,
I DO understand. There are times when I have to take steroids (prednisone) because of my disease and pred. makes you gain weight. I also know folks who suffer from depression and the anti-depressants apparently make people gain weight, too. That problem is particularly difficult because they’re depressed about their weight and the treatment adds on more.
You’re right — people can be very cruel to those who are overweight. I’ve heard the nasty comments, especially from the fitness-minded. That doesn’t help those who are struggling with their weight and it probably makes things worse. When I’ve developed the famous “moon face” from prednisone or when I gained 20 pounds from then-undiagnosed thyroid disease, I’ve heard the unkind comments and they really DO hurt! I just had to buck up, realize that the ignorant people didn’t know me or even want to understand, and that I was doing the best I could. That’s all we can do — our best.
Being healthy is all about a lifestyle, not just about calories and eating the wrong things. The folks I know who are morbidly obese suffer from depression. At this point, it doesn’t really matter which came first — the excess pounds or the depression — because it’s symbiotic. It’s difficult to get off that path.
With Lupus, it would be very easy for me to become obese. My joints hurt much of the time and bone-deep fatigue is one of my worst symptoms. I’m classified as homebound, which is why I have home health and a housekeeper. I only leave my home for church and have assistance to do my shopping. I really, really have to actively fight depression and the urge to simply stay in bed when I’m in pain. And I have to be very careful about my eating habits — it’s too tempting, especially when I’m hurting the most, to snack, eat convenience foods, or call for fast food delivery.
But, since I’m homebound, I’ve had to reinvent my life. I have always enjoyed cooking to some degree but now, with health issues and being on a tight budget, I’ve made a hobby out of cooking nutritious and delicious meals from scratch, with assistance. I like to grow some of my own vegetables and herbs in containers on my porch. And, since I can’t go out with friends very often, I invite them to my home for healthy meals. It’s a pleasure and blessing for them, since they work, and it keeps me in touch with people.
Also, I have physical therapy here at home and I’ve used it to motivate myself to exercise every day. I can’t do a lot or anything heavy, but I was pleased to see that even light, aerobic exercise makes a difference. It helps my sense of well-being and, of course, keeping my muscles fit helps support my joints. I may have an incurable disease over which I have little real control, but I AM determined to fully exert that little control I have through what I eat and exercising as best I can.
I guess what I’m saying is that no matter what challenge we face, when we give ourselves over to futility, there is no chance that things will improve. There are times when I become very disillusioned, when I’m in a bad Lupus flare as I am right now despite the fact that I see my docs, take my meds, cooperate fully with physical therapy, eat right, and exercise but I’m in too much pain to even go to church. It’s discouraging. But I simply can’t give up.
Several weeks ago, my home health aide said something that made me cry after she was gone. She said, “You know, you’re not going to get any better. I know you try to do everything you can in hopes of getting better, but this is as good as it’s going to get. You need to deal with that.” I don’t think she meant to be cruel — she probably thought she was giving me a necessary wakeup call — but it hurt because it seemed to me an attempt to quash hope. Faith and hope — that’s all I live on. No, I don’t logically expect that my doing 15 leg lifts a night and eating lots of spinach in various ways is going to cure me but it makes me feel like I’m doing SOMETHING to improve my lot and it helps me to keep positive and motivated.
There are people who, for whatever reason, want to quash hope and dismiss little bits of progress. Don’t let them. Ever. It’s those little bits of progress, when added up and not abandoned, can and do effect positive change over time. We are an impatient society, though.
[Comment deleted by Elf]
I was thinking about this…if the “overweight” person is genetically predisposed to the “condition” or if it is the result of medical treatments such as prednisone, and if being “overweight” is actully linked to living longer; wouldn’t taxing “overweight” folks be a violation of equal protection clause and/or the American’s With Disabilities Act?
Hmmm….
Are some of you that are saying overweight people don’t really have the choice or the wherewithall to change their eating habits some of the same that are saying that the GLBT folks [b]can[/b] change and be heterosexual? I have been in a depression for three years. I gained 20 pounds, but recently took 15 pounds off by changing my eating habits. I am still using anti-depressants, but I made the choice to eat better. I have friends who are obese. When we go out to eat, they “pile-it-on” when it comes to food. It is a choice, but not an easy one.
BTW, I was also on prednisone. I hate what it did to me. Unless I am dying…never again!
I’m trying to see how far we take this principle, #14. If potentially causing costs (via excess weight) to some Collective we are all compelled to join is cause for imposing a tax on someone, why isn’t imposing a similar tax on someone who is undeniably causing costs (via illness) to that same Collective? My apologies for making it personal.
Perhaps we should tax those with HIV or the pre-disposition to contract HIV at a higher rate in order to compensate for the added expense that we all have to pay. After all, unprotected sexual activity is completely a matter of choice. No?
Here’s a little story of something that happened years ago, when my kids were in elementary school:
A presidential election was going on, so the school decided to hold an “election” where the kids would vote on either Skittles or Reese’s Pieces the day of the real election. Skittles won by a single vote. The principal and I were talking a few days later, and related the story to me, quite pleased that her students had participated in this democratic exercise. I was horrified.
I then told her she had sent exactly the wrong message to her charges, insofar as they learned that elections have no consequences. If she really wanted them to learn a lesson in democracy, she would have subsequently banned the possession, sale and consumption of Reese’s Pieces at her school, searching lockers, book bags and desks for the contraband sweets. This, naturally, would have caused great consternation amongst RP-eaters, who would doubtless organize and campaign for the right to consume their snack at the expense of Skittles-munchers come next election. Skittles fans would no doubt oppose this initiative and launch a campaign of their own. Rancor would surely follow, but hey…that’s democracy.
Then, as the ill will reached a crescendo, the principal could point out that maybe, just maybe, some things are best decided by individuals instead of the collective and that liberty is, in the end, the best lubricant the machinery society has.
I think my point was made.
RE: ““A natural response to this cost would be to say that the people imposing it on society should be required to pay it—
I completely agree — but why do it in a tertiary way by giving money to the government through taxes which then redistributes it to a third or fourth party. Clearly that is inefficient and a poor use of money.
So let’s simply institute Jeffersonian’s solution: [blockquote]”Overweight and obese people are only a burden on others insofar as others are compelled to support them via taxation. In short, this isn’t a problem of obesity, it’s a problem of socialism.”[/blockquote]
Indeed, Sarah. And why is it someone’s purchase of health care is somehow “imposing (costs) on society” when that same person’s purchase of strawberry jelly, movie tickets, belt sanders or sweatshirts is not?
I don’t mean to be facetious, but shouldn’t we talk about taxing the fatcats and fatheads, instead?
OT, I know, Prejudice against overweight folks may be one of the final frontiers in the civil rights movement but I don’t see anybody eager to take up the banner at Gen Con.
Jeffersonian,
Unless you want to blame my parents for giving me faulty genes, there is absolutely nothing I could have done to avoid having Lupus. But whatever I CAN do to lessen the effects of the disease even slightly, I HAVE done and AM doing. My last post was meant to encourage those who are overweight to consider the same and to express empathy. There was no need to go nasty but if that makes you feel like you won the “argument,” whatever.
I forgot to add that there increasingly ARE penalties for not following doctors’ orders. The doctor can drop you, and I know people who have had it happen to them. I may have an odd disease for which there is no cure but the medical community (and, increasingly, insurance companies) still expect people to follow orders and do what they can to help themselves.
Well then, there are lots of people who lead lifestyles and make irresponsible decisions that create a health care burden. Let’s start with HIV/AIDS. People, most especially homosexuals act irresponsibly, engaging in unprotected sex and then demand free health care if they claim they can’t afford to pay. Perhaps there should be higher taxes on those who engage in irresponsible behaviors like unprotected sex, including those with HIV/AIDS. I’m sure there are many other such examples of groups who create ridiculous burdens who should be subjected to a higher tax rate.
I hope that most people on this thread, which wandered here and there, are agreed that the answer to Leonhardt’s question, “Should we tax those who are overweight?” is “No!”
teatime, I have a friend who struggles with lupus. You have my sympathy and admiration for your effort. My friend is very heavy. I don’t know if this is related to prednisone use, and I don’t ask. It seems to me that weight loss would improve her joint pain, but she has multiple doctors to tell her that. Whether or not suffering from a condition which requires medication, as someone said above, obese people know they’re fat. Medical people can and do tell them about the associated risks.
For me, in addition to correction of an underlying thyroid condition, weight control comes from a regular program of weight-lifting. Muscle uses more calories than flab. For the gentleman above who has tried everything else, I’ve heard of men who use something called kettle balls at home if they don’t want to join a gym. You might want to consider it; start cautiously and be regular about it. Other than trying to avoid fried foods and not having high-calorie desserts too often, I haven’t had to go on “a diet.”
[blockquote]Unless you want to blame my parents for giving me faulty genes, there is absolutely nothing I could have done to avoid having Lupus. But whatever I CAN do to lessen the effects of the disease even slightly, I HAVE done and AM doing. My last post was meant to encourage those who are overweight to consider the same and to express empathy. There was no need to go nasty but if that makes you feel like you won the “argument,†whatever. [/blockquote]
My apologies for personalizing this, I was out of line. But the principle remains and it has nothing to do with moral culpability: Sick people increase costs to any centralized “system.” Is there a reason they shouldn’t be taxed at a higher rate, just like the obese?
The article insinuates that the obese already pay some kind of “tax” by receiving less wages. It also seems to infer that insurance companies could probably charge people more for being overweight. That could be an effective “market” position, and an incentive for people to count their calories.
It may be that government policies are part of the problem with causing obesity, combined with the food industry’s sophisticated knowledge of how to override people’s willpower. We’re wired to love fatty, salty and sweet things. Perhaps halting agricultural subsidies for corn or sugar might cause some prices to go up and be the “tax” the author suggests.
One place government should be involved in is funding independent research apart from the food industry, and requiring easy access to information, as it does already.
If we end “subsidies” for sugar, the price will likely drop significantly given that our federal policy on sugar is to prop up its price to the point that it is four times the world market price.
Is corn making us fat?
Katherine,
For a long time, prednisone was the main drug for Lupus. It has nasty side effects and one of them is weight gain which, in turn, can lead to diabetes. It’s a vicious circle. Nowadays, we’re lucky that we do have “steroid-sparing” medications, none specifically for Lupus but meds that have been found to help, nonetheless. Still, most of us do have to take pred. sometimes to knock out potentially life-threatening complications. My docs “remind” me often to maintain my current weight when I’m on steroids. Extra weight is very hard on inflamed joints and connective tissue.
Regarding the tax, I’ve only seen proposals to tax products (such as sodas and junk food) not people. I don’t have a problem with that. They’re putting big taxes on tobacco products to target smokers. Now, using the revenue for health care and programs as they say they will is another story entirely. The tobacco settlements were spent on a laundry list of things not related to education programs or health care/quit assist for smokers.
“Is there a reason they shouldn’t’t be taxed at a higher rate, just like the obese?” Jeffersonian, I know few families who are not “sick” in some way. The last thing I want is an actuary having more power deciding on my level of sickness and thereby rating. I know this problem is very complicated but I believe all Americans are in one pool. If we could think of it that way at least one portion of the debate might be simplified.
Thje trouble is protecgtive legislation. To be sure, obesityh may well increase health care costs, but this really isn’t the issue. The issue is whether a government, once given the power and authority to proscribe behavior that has not yet happened, have not been given the key to a suffocating tyranny of well-meaning. For the true Mummy society, absolute control is the only practical answer to concept of prevention. We have already gone a long way down this road, and I suspect there is no turning back. Larry