In addition to the uninsured, middle-class Americans with insurance are feeling the pinch as the costs outstrip increases in income. In response to the growing financial burden, President-Elect Obama has made accessible and affordable medical care a top priority.
Yet 70 percent of medical care costs, or $ 1.61 trillion, is attributed to unhealthy lifestyle choices (smoking, poor eating habits and lack of exercise). This raises a compelling question: who will foot the bill?
A report by the Vitality Group, a provider of employer health and wellness programs, highlights the disconnect between personal responsibility for maintaining one’s health and financial responsibility for medical consequences. While 82 percent of those surveyed felt they were personally responsible for the state of their health, only 44 percent felt they had a financial responsibility for the cost of medical care.
Over half of those surveyed felt that employers and government should absorb the financial consequences of unhealthful lifestyle behaviors, rather than the individuals who engaged in the behaviors. Researchers also reported that the participants were reluctant to pay for wellness programs designed to teach healthful habits.
Spotlighting the disconnect between lifestyle choices and financial consequences provides useful insight for policymakers and employers seeking to reduce medical care costs. Even with the availability of sophisticated technological tools, social engineering is an imprecise mix of science and guesswork. Consequently, a variety of experiments are likely to be undertaken with the hope that one or more will be successful in reducing unhealthful lifestyle behaviors.
One approach is taxing unhealthful behaviors. Alabama’s fat tax falls in this category. Beginning in January 2009, obese state workers will risk a monthly increase of $25 in insurance costs if they fail to reduce their weight.
Equally controversial is the approach being proposed by New York Governor David Patterson—an 18 percent sales tax on sugary drinks and sodas. Governor Patterson estimates that this tax, if approved, would generate an estimated $400 million in revenue to offset rising medical care costs resulting from obesity.
His model is based on the success of the anti-tobacco campaign. Certainly anti-smoking advertisements have contributed to a decline in smoking; however, researchers have also found a clear correlation between the increased cost of cigarettes and a reduction in the number of smokers. According to statistics cited by Drs. Tom Farley and Deborah Cohen in their book, Prescription for a Healthy Nation, every 10 percent price increase on cigarettes reduced sales by about 3 percent.
Whether smokers connected the cost of their behavior with the cost of treating smoking-related ailments was irrelevant. Some quit smoking because of the expense. Those who continued were forced to offset some of the medical costs associated with smoking. (Even so, a $7 tax would be required to fully cover the additional costs of medical care associated with smoking.)
In Governor Patterson’s model, sugary drinks are the equivalent of cigarettes. Americans consume one-third of their calories from sugar; half of those come from sugary drinks that nutritionists consider empty calories—the drink is high in calories and low on nutrition. In addition, sugary drinks fail to satisfy hunger. Consequently, the surplus calories in the sugary drinks are added to the calories consumed in food. For these reasons, many experts consider sugary drinks to be the most significant factor in the rise of obesity.
If Governor Patterson’s tax initiative passes, public health officials believe they will see a correlation in reduction of the number of overweight or obese individuals, similar to the decline in the number of cigarette smokers.
According to Art Carlos, chief executive officer of the Vitality Group, “The increasing need for health care arises from the treatment of illnesses and medical problems that are preventable through more healthful lifestyle choices. Despite advances in medicine, physicians cannot undo the damage resulting from long term abuse of our bodies and are limited in their ability to reverse a lifetime of unhealthful habits. The solution will emerge when we are required to take personal accountability for the way we choose to live.”
twice as much as other industrialized nations for medical care, yet we are
losing ground on the health front. In the near future, rising medical costs
will force us to answer the
question: who will be our brother’s keeper?
"Am I my brother's keeper?" Bible, Genesis, chapter 4, verse 9