The Burden of Healthy Living

Jacob Sullum | February 5, 2008

A Dutch study reported yesterday in the online journal PLoS Medicine undermines the fiscal argument for a government-led War on Fat, which says how much you weigh is everyone else's business because other people have to pick up the tab via taxpayer-funded health care programs. The researchers found that eliminating obesity would, over the long term, increase medical spending instead of reducing it:

Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures....

Obesity prevention, just like smoking prevention, will not stem the tide of increasing health-care expenditures. The underlying mechanism is that there is a substitution of inexpensive, lethal diseases toward less lethal, and therefore more costly, diseases.

The researchers compared the medical expenses of three hypothetical cohorts: obese people, smokers, and thin nonsmokers. They found that annual costs were highest among obese people until age 56, after which smokers were the most expensive group. But because both groups had lower life expectancies (80 and 77, respectively) than the "healthy-living" cohort (84), they had lower lifetime health care costs as well. Taking the long view, the thin nonsmokers cost the most, followed by obese people and smokers, in that order:

At discount rates of, respectively, 3% and 4% successful smoking prevention would result in additional health-care costs of €7.1 and €3.4 million (assuming costless intervention). For obesity prevention these figures would amount to €1.8 and €1.0 million. Only for discount rates above 4.7% would costless obesity prevention be cost saving. For smoking prevention to be cost saving, the discount rate for costs should be at least 5.7%.

The authors note that they considered only health care costs, leaving out "other potentially substantial costs and consequences" of obesity, such as reduced productivity and "the reduced well-being of family members due to morbidity and premature death." But the former cost would be borne mainly by obese people themselves through reduced earnings, and the latter should be internalized to the extent that obese people care about their family members. (If the government did not force some people to pay for other people's health care, medical costs would be internalized as well.) Notably, the study also left out taxpayer-funded pensions, which increase the burden that healthy-living people impose on the rest of society.

In my 2004 reason article about the War on Fat, I noted that research might find that obesity, like smoking, saves taxpayers money.

[via The Freedom Files]

Comments

Douglas Gray|2.5.08 @ 6:35PM|#

A group of legislators in Mississippi have introduced a new bill that takes aim at solving this issue - HB 282, which would make it illegal for restaurants to serve fat people.

See www.clevelandleader.com/node/4524

I guess the logic is the more you eat junk, smoke and drink, the sooner you die, and the less you cost the Health Care System.

.|2.5.08 @ 6:50PM|#

I guess the logic is the more you eat junk, smoke and drink, the sooner you die, and the less you cost the Health Care System.

I think that pretty much sums it up. Generally, all people have health problems in their last couple years of life that will cost a lot if treated. Eating right and exercising is only going to delay it.

The key is minimizing the number of total years a person lives. You want to minimize health care costs? Here's the solution: Everyone lives fast. Sex, drugs & junk food (and rock & roll!) for everyone. As soon as it becomes apparent that a person is going to start having health problems, bullet to the back of the head.

Ventifact|2.5.08 @ 6:51PM|#

Cool. Now we just need to deal with the moralism that fuels all this government largesse.

|2.5.08 @ 6:55PM|#

So the states atty generals are going to be refunding the tobacco companies money because it was taken under false pretenses? When this whole "because we have to pay for your health care" crap first came up, thinking people said, "Just wait a minute there. It's not that simple".

But unlike all of those states attorney generals, I haven't been to college so I've probably been talking out of my ass for the last 10 years or so.

Oh well, at least the shakedown was done in the spirit of bipartisanship.

The Wine Commonsewer|2.5.08 @ 6:56PM|#

Is it just my crappy ISP or is H&R taking months to load a page lately?

|2.5.08 @ 6:59PM|#

Is it just my crappy ISP or is H&R taking months to load a page lately?

It appears the squirrels are back in the building. IOW, it ain't just you.

The Wine Commonsewer|2.5.08 @ 7:06PM|#

Thanks, J

SIV|2.5.08 @ 7:10PM|#

It appears the squirrels are back in the building. IOW, it ain't just you.

The squirrels are optimized.... by the Rubicon Project!

I prefer natural squirrels, perhaps Ron Bailey could make the "libertarian case" for these new optimized squirrels. He is probably on the payroll for this nefarious rubican Project and its evil plans for world optimization.

|2.5.08 @ 7:14PM|#

"I guess the logic is the more you eat junk, smoke and drink, the sooner you die, and the less you cost the Health Care System."

So, cannabis and other illegal drugs are a problem, because?...

Shannon Love|2.5.08 @ 7:16PM|#

We seem to have a cultural imperative to believe that there is one perfect way to live, one perfect set of choices and tradeoffs. (Perhaps its a hold over from religion.) The idea that life involves tradeoffs and that different people prefer to make different tradeoffs, seems completely absent.

For people who see the State as the solution to all problems, the idea of one perfect lifestyle translates into using government coercion to force people to adopt that lifestyle.

SIV|2.5.08 @ 7:30PM|#

Sqirrels, thy name is:

Waiting for optimized-by rubiconproject.com

-from Google, Yahoo, and Tacoda (AOL) to AdBrite to HispanoClick-

HispanoClick eh?

Why does that have a ring of "familiarity"?

The Wine Commonsewer|2.5.08 @ 7:40PM|#

Might be the slew of ads showing up top. I swear, this page is loading like dial-up today. Sure cuts into the incentive to loaf instead of work.

Can't stand waiting.

|2.5.08 @ 7:50PM|#

We seem to have a cultural imperative to believe that there is one perfect way to live, one perfect set of choices and tradeoffs. (Perhaps its a hold over from religion.) The idea that life involves tradeoffs and that different people prefer to make different tradeoffs, seems completely absent.

Shannon Love,
And they never realize that that thinking is the height of arrogance and egotism. Get over yourselves folks. You haven't found the secret of life or the key to fulfillment. If those exist, Their different for everybody.

Rakune|2.5.08 @ 8:02PM|#

I guess you could reduce health care cost to almost zero, if you apply a .44 to the head of everybody who has the temerity to get sick. Maybe even turn a profit if you avoid damaging gold filings.

/evil bastard off

Oh yeah, I think the server squirrel is taking part in Stupor Tuesday or maybe the Iranian Navy cut the cable to DC.

|2.6.08 @ 2:00AM|#

This may be more about aesthetics than money. Its really bad for a nation's self-image if its full of fat people. The other nations tend to point and laugh.

|2.6.08 @ 10:00AM|#

It sounds like the researchers left out the increased costs imposed on the state retirement system by long-lived people.

I wonder if there isn't a Fourth Iron Law:

Entitlement produce perverse results.

I'll have to think about it.

LarryA|2.6.08 @ 10:11AM|#

Initial reaction: Well, duh!

We seem to have a cultural imperative to believe that there is one perfect way to live, one perfect set of choices and tradeoffs. (Perhaps its a hold over from religion.)

In my experience it's an idealization of the way you thought things were when you were a child.

Sitting with my folks in our (one) family car watching circus acts in The Greatest Show on Earth at the drive-in movie sipping Coca Cola from a glass bottle. Priceless.

I found out later may parents took us to lots of drive-in movies in the early 1950s because we were less likely to get polio.

This may be more about aesthetics than money. Its really bad for a nation's self-image if its full of fat people. The other nations tend to point and laugh.

Not in nations where people are starving. In much of the modern world, and through much of world history, obesity=prosperity.

Neu Mejican|2.6.08 @ 11:09AM|#

Yes,

All government initiatives must be motivated by the cost. There is no other reason for government action than long-term savings. So,logically, anarchy is the ultimate goal of government programs.

Or something.

Maybe public health is an end rather than a means to an end.

Just maybe.

|2.6.08 @ 11:33AM|#

ok, non-obese, non-smoking people live longer and require some healthcare as long as they live, especially at the end of their lives - but won't they also be more productive, for a longer period of time, because they're healthier? if so, wouldn't the increased healthcare costs be offset, and maybe outweighed, by increased earnings and economic production and growth?

ChrisO|2.6.08 @ 12:58PM|#

How is it possible that I'm the first one to mention Logan's Run in this thread?

economist|2.6.08 @ 3:19PM|#

No need for people to die early. They just have to be willing and able to individually cough up the money to pay for the medical care necessary to extend their lives. Those of us who rather live fat, die in our sixties, and leave a heavy corpse can continue to do so. There. Everybody wins.

economist|2.6.08 @ 3:28PM|#

Neu Mejican,
Your definition of "public health" is too broad. Our point here should be to point out that paternalistic meddling in individual choices (to eat or not to eat "unhealthy" foods) cannot be justified under public health, as the decision of obese people to do things that make them obese does not necessarily impose costs on others(unless the government makes others bear those costs). The true realm of public health should be mainly restricted to three areas, all where one individual's choices necessarily imposes costs on others against their will: Controlling the spread of infectious diseases, regulating pollution, and public sanitation(making sure people don't have open cesspools near their houses where a new strain of cholera has developed). Other than in these areas, one's health habits are none of the government's goddamn business.

Neu Mejican|2.6.08 @ 3:38PM|#

economist,

The true realm of public health should be mainly restricted to three areas, all where one individual's choices necessarily imposes costs on others against their will: Controlling the spread of infectious diseases, regulating pollution, and public sanitation(making sure people don't have open cesspools near their houses where a new strain of cholera has developed). Other than in these areas, one's health habits are none of the government's goddamn business.

I am pretty sure that I never gave a definition of public health...

However, since you have been specific, I will say that your definition is too narrow (food safety comes immediately to mind). Now that we have established that our disagreement is due to different underlying assumptions, you can attempt to justify your specific restrictions on other principles.

Of course, what we may be disagreeing on is what it meant by a justifiable government action to reduce obesity. I would say programs that serve to provide information to help an individual make an informed choice are not restrictive or liberty, and don't constitute "paternalistic meddling."

Neu Mejican|2.6.08 @ 3:39PM|#

"of liberty"