My response to "listening exercise" on proposed NHS reforms
Arizona is proposing fining obese Medicaid recipients who do not comply with a diet. People are complaining that this represents a "nanny-state" mentality but if the state is providing your healthcare and you are behaving in a way which makes this more expensive, why shouldn't the state try to recoup some of that extra expense?
Fining non-dieters sounds impracticable but it would be fairly straightforward to allocate a specific cost to a wide range of activities which would tend to make people less healthy and hence to require more expensive healthcare. One could assign such a cost not only to each cigarette or each unit of alcohol but also each calory of food consumed. Thus there could not only be components of tobacco and alcohol duty which were badged as related to healthcare costs but also a health tax on food and drink related to calorific and salt content. As an example this would either make diet drinks cheaper than their sugar-containing equivalents or else the manufacturer would have to bear the cost, making it less attractive for them to produce and promote high calory drinks.
A similar financial approach could be applied to other behaviours impacting on health. For example, getting a bus instead of walking or cycling reduces fitness. Hence one could impose a health tax on such journeys as well as having a specific component of duty on petrol badged as the health cost of driving instead of walking. Conversely, one could financially reward activities expected to increase fitness. For example, there could be a government-provided health subsidy for swimming tickets, gymn membership and purchase of exercise equipment and bicycles.
We are told that the cost of providing healthcare to the population is rising and that one reason for this is that people make unhealthy lifestyle choices. The proposed approach makes explicit and fair the relationship between the state as the provider of universal healthcare and the citizen as the consumer. It says that people are free to make choices and can choose behaviours which will be on average increase the costs of their healthcare but that when they do so they should be expected to bear this additional cost themselves rather than expecting other members of society to do so. Implementing this additional revenue stream would be seen as fair and would alleviate the financial pressures which are claimed to be driving these reforms.
Fining non-dieters sounds impracticable but it would be fairly straightforward to allocate a specific cost to a wide range of activities which would tend to make people less healthy and hence to require more expensive healthcare. One could assign such a cost not only to each cigarette or each unit of alcohol but also each calory of food consumed. Thus there could not only be components of tobacco and alcohol duty which were badged as related to healthcare costs but also a health tax on food and drink related to calorific and salt content. As an example this would either make diet drinks cheaper than their sugar-containing equivalents or else the manufacturer would have to bear the cost, making it less attractive for them to produce and promote high calory drinks.
A similar financial approach could be applied to other behaviours impacting on health. For example, getting a bus instead of walking or cycling reduces fitness. Hence one could impose a health tax on such journeys as well as having a specific component of duty on petrol badged as the health cost of driving instead of walking. Conversely, one could financially reward activities expected to increase fitness. For example, there could be a government-provided health subsidy for swimming tickets, gymn membership and purchase of exercise equipment and bicycles.
We are told that the cost of providing healthcare to the population is rising and that one reason for this is that people make unhealthy lifestyle choices. The proposed approach makes explicit and fair the relationship between the state as the provider of universal healthcare and the citizen as the consumer. It says that people are free to make choices and can choose behaviours which will be on average increase the costs of their healthcare but that when they do so they should be expected to bear this additional cost themselves rather than expecting other members of society to do so. Implementing this additional revenue stream would be seen as fair and would alleviate the financial pressures which are claimed to be driving these reforms.
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