EVEN IF YOU TRIED, as I did, to avoid this year's health-care debate, it was impossible to ignore some of its startling statistics. Take, for instance, the annual medical costs linked to obesity, as reported in July by the Centers for Disease Control and Prevention: $147 billion, more than 7 percent of the nation's health-care tab of more than $2 trillion.
The Little Idea: Call It What You Will
Once you've settled on differential pricing, the rest is just semantics: Fat tax, or skinny rebate? The price for premiums for heavier Americans is 0. The cost for fitter Americans: .
About a month after the CDC report, the processed-food industry, with support from the American Heart and Diabetes associations, unveiled its Smart Choices Program, which approves special labels for healthy foods. Among the products stamped better choice were Froot Loops, Frosted Flakes, and dozens of other candy-for-breakfast items.
When I heard about this, I literally slapped my forehead. The CDC has indicated that as much as 75 percent of U.S. health-care spending goes to treating chronic maladies, many of which are indirectly attributed to our slothful lifestyles and dismal diets. I understand why so much of the health-care debate is focused on dealing with our symptomswe're a messbut now it's time to focus on the cause of our woes.
Last year, the nonpartisan Trust for America's Health, in Washington, D.C., released a study concluding that every dollar invested in things like promoting physical activity and improving food choices yielded $5 in health-care savings. That's the kind of return on investment that any budget hawk should love. But incentives for nutrition and exercise amount to less than 10 percent of the health-care bill. Forget Obamacare, I thought; how about Obamacize? Somethinganything!to get us moving more and eating better.
Everyone's aware that our self-destruction has been under way for a while nowthat kids play too many video games and Type II diabetes is a corn-syrup-induced epidemic. We also know the solution: more nutritious food, less obscene snarfing of it, and (gasp) some hearty exercise. But can we get there without instituting push-up panels? Yes, and the answer is cash. Let's put our money where our mouths have been for too long and begin paying people to get fit.
Start by discounting insurance for people who meet certain fat and cholesterol standards. Many private-sector companies have already caught on and pay employees to play. Smart outfits like Clif Bar and Chesapeake Energy have in-house fitness centers. Even General Motors managed to fill a lunchtime calisthenics class for autoworkers by promoting it with "Get in Shape for Hunting Season!"
Cash can be givenand cash can be taken away. Airlines already require passengers to pay more for spreading across two seats. Smokers now pay hefty tobacco taxes and insurance premiums to offset the cost of smoking-related diseases (which might have something to do with smoking rates dropping from 44 percent, in the 1950s, to 20 percent today.) Similarly, some in Congress now advocate a tax on corn-sweetened soda to help fund health-care reform. (Great idea! And let's also dial back the heavy subsidies that created the overabundance of corn in the first place.) Meanwhile, several life-insurance companies have taken the first steps toward differential pricing by offering discounts to customers who maintain a doctor-certified body-mass index of between 19 and 25, since healthier customers live (and pay) longer.
But if you think the health-care debate has been ugly up till now, try convincing an ideologue that gluttony and sloth aren't in the Bill of Rights. Fox News's Glenn Beck gave a preview of how any government intervention in the nation's obesity crisis might go: "I'm going to go on living my life the way I choose to live it, and if that includes 18 hours of TV and Doritos, that's my choice, baby!"
Um, good luck with that. Meanwhile, the $147 billion per year to treat diseases of choice seems like a lot of money to leave on the table. If we really want a return on investment from health reform, let's start with what matters most: our actual health. It may be the only kind of change we can afford.