Notes from an emergency room doctor: Good health
is far more a consequence of good personal choices
than good luck. Insurance companies have long
been aware of that and that's why they impose
costly surcharges on people with poor health habits,
Fancy mathematics has calculated the medical
cost of smoking to be more than two bucks per
pack. I guess someone simply divided the number
of packs of cigarettes smoked into the cost of
treating lung cancer, emphysema, and other smoking
related diseases. But a pack of cigarettes probably
has far greater costs than that. No one can accurately
measure the value of more than 400,000 lives lost
in smoking related deaths per year. And how do
you calculate how many houses, factories, and
forests burn to the ground due to a smoldering
cigarette? You can't.
Insurance industry practice has been to make
an individual responsible for his own bad habits
by charging more to those that choose to incur
greater risks. Unfortunately, not everyone is
insured, it's impossible to monitor personal habits,
and the surcharge that insurance companies charge
doesn't accurately assess the real costs to society,
like those mentioned above.
Now that congress is contemplating taking over
the job that insurance companies now do - paying
the medical bills - they're also busy targeting
the sources of bad health. During the recent debate
over the health consequences of cigarette use,
an RJR Tobacco executive told congress that just
as nicotine was addictive, "any enjoyable
activity was addictive," even eating sweets.
Rep. Henry Waxman countered. "You and I
know," he said, "Twinkies don't kill
a single American a year. The difference between
cigarettes and Twinkies ... is death."
Well, simplistically Rep. Waxman is right -
"Twinkies" don't cause death. But smoking
a few cigarettes won't kill you either. What the
government needs to focus on is a total picture
of health risk. I like the government's idea of
taxing those things associated with bad health.
They're busy with tobacco now but alcohol could
be taxed far more too. The health tax on a bottle
of alcohol should not only cover alcohol related
diseases like cirrhosis and liver cancer but should
factor in the cost and consequences of all those
drunk driving accidents, and stunted newborns
who suffer from fetal alcohol syndrome.
But alcohol and tobacco are easy targets. Americans
are at great risk of cardiovascular disease because
of our eating habits. Why not a tax on the cholesterol
content of food or the fat content of meat and
milk. A quart of non-fat milk should be cheaper
than whole milk, not only to encourage a healthier
diet but pay for the health costs of a bad one.
And, of course, we should tax Twinkies. You, and
I, and Congressman Waxman know that though "Twinkies
don't kill," they're not "health food"
The government could go beyond the pale and
subsidize the good as well as taxing the bad.
Fruit and vegetables could be cheaper. Home exercise
equipment and health club memberships could be
bought tax free. If the television is on more
than four hours a day, tax it.
The best of all situations would be if government
didn't have to interfere in our personal choices.
But we have become a society where individual
responsibility is passť. Most people don't want
to pay for or admit responsibility for their nasty
habits. So, maybe we all need to be led a little
toward the right path.
Because elected officials are so dependent on
special interest contributions to stay in office,
they ought to create an independent authority
to make those difficult "health tax"
decisions. I'd call it "The Supreme Court
of What's Good For Us." It would decide what
the real health costs are of all our consumptions
and habits and tax them accordingly. However,
if they do create such a court, I will decline
any appointment. There's no way Dr. Pollack would
vote to increase the tax on ice cream, pizza,
chocolate, and a good white zinfandel.