April 13th, 2009
12:28 PM ET

Banning or taxing bad health habits to cut health care costs

By Andrea Kane
CNNhealth.com Producer

Two articles have recently come out tackling the twin pink elephants in the room: one is an editorial in the New England Journal of Medicine in favor of taxing sugary drinks (to reduce consumption and possibly raise revenue for anti-obesity programs), the other is a story in Time magazine making the case for an outright ban on cigarettes.

The views in each make plain old sense: Ban or tax that which we KNOW is bad for our health to improve health and cut runaway health care costs.

In the case of cigarettes, the writer notes that cigarette smoking costs an “estimated $100 billion in health-care costs… annually.” In the case of sugary beverages, the authors write, they “may be the single largest driver of the obesity epidemic” (pointing out that the only studies that found no link between sugary-drink consumption and obesity are – surprise! – those funded by the beverage industry).They estimate obesity-related problems cost about $79 billion annually – about half of which is footed by the American taxpayer (you and me).

On the one hand, their arguments make me morally uncomfortable: Who are we to tell other people what to do? Isn’t it too “Big Brother”? Too paternalistic - especially when we are talking about taking steps that will affect the so-called underclass (aka: “the poor”) most? But in both cases, the writers note that poor people have the most to benefit from cutting back on sugary soft drinks and quitting smoking. This is especially true in the case of smoking since “[c]igarettes, to an extent, have become an indicator of lower socioeconomic status.” Yet, nobody likes to be told how to live or wants to feel coerced into any course of action – however “good for you” it might be.

But on the other hand, why can’t we just admit that advocates for taxing and banning these vices have a point? Banning smoking WILL reduce cancer and cardiovascular (and a whole host of other) deaths. Making soda expensive WILL force people (especially poor people, who presumably also can’t afford all the lifelong medications they’ll have to take for diabetes, high blood pressure, etc.) to drink water and thus cut out 250 to 300 empty calories a day, which over the course of a year – not to mention a lifetime - really do add up.

What also adds up are the costs: the costs associated with caring for the sick and the costs associated with lost productivity due to illness. Make no mistake, the American taxpayer (you and I) will have to pay one way or another - via higher health-care costs, the inability to get affordable insurance, or perhaps through cuts to programs such as Social Security, public education, work training programs (or the arts, national parks, etc.) in order to fund the ballooning costs associated with Medicaid/Medicare.

So what is the right answer? Where do your rights (to smoke, to drink liquid calories, to do what you want with your own body) end and my rights (to breathe clean air, to not have to pay for someone else’s problems) begin? I want to hear what you think.

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