Dr. Clif Cleaveland
Do each of us bear certain responsibilities to practice good health habits? Should the provider of our health care, whether a private company or government, insure us regardless of our habits and activities?
Should risky health behaviors simply be discouraged, or should a monetary penalty be assessed for their practice?
These questions assume greater importance as both presidential candidates offer proposals for wider access to health care.
Consider these specific situations.
n Smoking — Data last gathered in 1999 indicated that medical expenses of cigarette smokers exceeded those of non-smokers by more than $1,600 annually. Undoubtedly, this cost has increased in the subsequent decade. No statistics are available for users of smokeless tobacco.
The additional health-care costs for smokers could be addressed by adding a tax that would be dedicated to covering the extra health-care costs of tobacco users. For a smoker of a pack of cigarettes per day, a health tax of $4 dollars per pack would cover the 1999 expense.
n Alcohol — The total impact of alcohol abuse on health care costs is difficult to estimate. In addition to personal health injury, liver damage, gastritis and brain injury, alcohol is responsible for many casualties related to car crashes and violence. Fetal-alcohol syndrome, the persistent injury to children by mothers who drink to excess, must be included. Ten-year-old data from the National Institute of Alcohol Abuse and Alcoholism estimated annual costs of alcohol abuse treatment at $5.5 billion, medical treatment at $19 billion, and total costs to U.S. society of alcohol abuse at $185 billion.
To cover such costs, staggering and impractical health taxes would have to be assessed to alcohol purchases. Should a lesser tax dedicated to treating victims of alcohol use be added to beer, wine, and whiskey?
n Obesity — Excess weight rivals smoking in its impact on American health. When we gain weight, we significantly increase our risk of developing adult-onset diabetes, heart and circulatory disease, dementia and cancer. Ten-year-old data from the Centers for Disease Control estimates a yearly cost of $78 billion to treat obesity and its related conditions. Unlike tobacco and alcohol, there is no easy method for adding a health tax to products such as fast foods that are more likely to cause obesity.
As an alternative, should overweight persons pay higher deductibles or co-payments in a national health insurance system? Would this serve as an incentive for weight reduction? Would these higher charges be discriminatory?
n Motorcycle helmets — Twenty states, including Tennessee, require motorcycle riders to wear helmets. States without such laws have been persuaded that these regulations infringe on personal freedoms, despite studies that show that unprotected riders sustain many more serious and complex head injuries in accidents. We mandate seat belt use for occupants of automobiles on a national basis. Should national law require helmets for motorcycle riders, especially if their health care costs are to be covered by a national plan?
n Guns — Firearms are involved in numerous accidental and intentional injuries. I have not found an estimate of the resulting costs for treatment of victims. Would an aggressive educational campaign that was focused upon firearm safety reduce injuries substantially? Or should the costs of firearm-related mortality and morbidity be factored into the purchase price or the licensing fee for personal weapons?
n Hazardous activities. This list is quite extensive and includes sports such as boxing, football, auto-racing and individual activities such as hang-gliding and motorized trail-riding where there is an increased chance of injury. Should sponsors or participants in activities associated with a significant chance of injury pay a premium for health insurance coverage?
Americans respond to the idea of fairness, that no one will be accorded special privileges in the public marketplace. The challenge in a national health insurance scheme is to determine if and how personal choices and responsibilities should influence coverage and payments. We could assess taxes and penalties on unhealthy behaviors, hoping that these would promote healthier lifestyles. Alternatively, we could reduce health-care payments for persons practicing healthy habits. If we choose a single level of payments, we must design sustained educational campaigns to promote healthy behavior.
Extending health insurance coverage more widely in our population will entail significant increases in federal funding. To lessen the financial impact, I favor health taxes on substances and devices that are associated with higher risks of disease and injury along with aggressive advertising of good health practices. Let me know your sentiments about this issue.
Contact Clif Cleaveland at firstname.lastname@example.org.