Again, With Feeling: Thinner Is Not Cheaper

In a long New York Times op-ed piece, food journalist Michael Pollan argues that "our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform…the food industry." He says Big Food encourages people to eat too much of the wrong stuff, which raises health care costs by promoting diet-related disease. (Although Pollan says "there's lots of money to be made selling fast food," he never considers whether consumer choices, as opposed to corporate mind control techniques, might help explain why this is so.) Pollan concludes that controlling medical spending will require a soda tax, "a federal campaign to discourage the consumption of sweetened soft drinks," "school lunch reform," restrictions on food marketing, an overhaul of farm subsidies, and "the development of regional food systems."

I'm all for eliminating agricultural subsidies (as opposed to shifting them toward nutritionally and ideologically correct producers, which seems to be more like what Pollan has in mind), and I have no problem, in principle, with trying to improve school lunches. The rest of Pollan's ideas offend my libertarian sensibilities, but I'd like to focus on his fiscal claim: Is tackling obesity a good way to control health care costs?

First it should be noted that Pollan does a lot of double counting when he totes up the medical expenses attributable to overeating. He claims "we're spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet." That first number is based on the difference between the annual health care costs of obese people and the annual health care costs of thin people. The vast majority of that money goes to treat diseases associated with obesity, not obesity itself. Hence the $147 billion already includes much of the $116 billion spent on diabetes and the "hundreds of billions more" spent on cardiovascular disease and cancer. In fact, to the extent that the latter three conditions are associated with obesity, the first number already accounts for them. Pollan uses the additional numbers to reinforce his claim that "the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained…by our being fatter." But in this context they are big fat red herrings.

According to the study that generated the $147 billion estimate, obesity accounts for about 10 percent of health care spending, which hardly makes it "the elephant in the room" of health care reform, as Pollan claims. But even this figure is misleading, because it is based on a comparison of annual costs. As I have pointed out before, obesity is associated with higher annual health care costs but lower lifetime costs, because obese people tend to die earlier than thin people (or those who are merely "overweight"). The upshot is that reducing obesity will, over the long term, raise health care costs, exactly the opposite of what Pollan is claiming. You can, of course, argue that reducing obesity is nevertheless a good thing, that extra years of life should be welcomed, instead of being seen as an added burden on the public treasury. But that is not the argument Pollan is making.