What costs our health care systems more: treating alcoholism, obesity and cancer caused by smoking or having people be healthier and live longer?
You Cost More, You Pay More
With increasing regularity we hear about countries imposing taxes on unhealthy foods, Denmark being the latest example I know, where a “fat tax” is put on foods with high amounts of salt, sugar, saturated fats and alcohol, the big four food ingredients most closely related to rising obesity rates and heart disease. A good while before that, Arizona planned to have obese enrollees of the public health care program “Medicaid” pay an extra $50.
The argument behind all these is that unhealthy behaviors, may they be excessive drinking, being overweight or a smoker, cost health care systems extra, and therefore people indulging in these should also pay extra.
Be A Good Boy, Die Earlier
Already in the Arizona tax article I talked about where we would have to draw the line between “healthy” and “unhealthy” behaviors, as from a certain point of view you could even classify biking in dense traffic as rather unhealthy.
Now Tim Worstall of Forbes magazine (motto “The Capitalist Tool”) opens up a different perspective: let people booze, smoke and eat to their heart’s content, as their earlier deaths will save public health systems a lot of money.
As proof Mr. Worstall cites a study commissioned by the Dutch government, that looked at health care costs incurred by people from age 20 to death. The study found:
Until age 56 annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions.
Life Quality Vs. Costs?
I can’t argue with the numbers. Yet this calculation reminds me of the movie Logan’s Run, where, after some unspecified catastrophic event, people live in a large, sealed dome. Machines take care of tedious tasks and you can pursue whatever pleasures you wish. That is, until the day you turn 30, where you will be killed. Because this society has determined that at 30 you become a burden, and resources and population have to be kept at an equilibrium. This community functions, but at what price?
Is Mr. Worstall’s argument cynical or merely realistic? Should it be socially more acceptable to be obese, smoke and drink, because society actually benefits from it? Should a state actually be thankful when its citizens lead unhealthy lifestyles? Or does it have the responsibility to ensure people will lead long and healthy lives, no matter what the cost?
Picture courtesy of Kyle May.