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Posts Tagged ‘Obesity’

As part of my “great moments” in government series, I periodically share stories about really foolish regulations and really wasteful spending.

And sometimes I’ll even have a story that combines dumb regulation and boondoggle spending. For instance, you won’t believe the government’s inane approach to different-sized condoms.

I also have a satirical series about “great moments in human rights” and it’s time to augment that collection.

Europe’s political elite may decide that being overweight is a protected disability.

Here are some passages from a BBC report.

The EU’s top court is considering a test case which could oblige employers to treat obesity as a disability. Denmark has asked the European Court of Justice to rule on the case of a male childminder who says he was sacked for being too fat. …The court’s final ruling will be binding across the EU. It is seen as especially significant because of rising obesity levels in Europe and elsewhere, including the US. …Audrey Williams, an employment discrimination expert at Eversheds law firm, said the judges would have to decide “whether obesity itself should trigger preferential rights…”. If the judges decide it is a disability then employers could face new obligations, she told the BBC. Employers might in future have a duty to create reserved car parking spaces for obese staff, or adjust the office furniture for them, she said.

Yes, you read correctly.

If the European Court of Justice rules the wrong way, you can eat all you want, knowing that you’re part of a protected class and that your employer has to incur all sorts of costs for your benefit.

Now it’s time for a bit of libertarian dogma. I think people have the right to over-eat, and I don’t think the government should be trying to impose lifestyle choices, either through coercion or by tilting our behavior with penalties or subsidies.

But I also think we should bear the costs (or reap the benefits) of our behavioral choices. In other words, we don’t have – 0r shouldn’t have – the right to compel others to like us, to hire us, to promote us, or to incur costs on our behalf.

Simply stated, a free society should have free association.

If you want to read more “great moments in human rights,” here’s an ever-growing list.

And let’s add one more to the list.

The federal government has now decided that taxpayers should be liable for the cost of sex-change surgeries.

Here are some excerpts from a story last month in The Hill.

Medicare beneficiaries who are transgender may now receive coverage for sex reassignment surgeries, a federal health board ruled Friday. The decision lifts a decades-old ban on coverage for sex-change operations with Medicare and hands a major victory to transgender rights advocates who argued the rule was discriminatory.

I suppose you could categorize this story as an example of wasteful spending, but I doubt there are that many people over age 65 who will be signing up for this surgery. So while Medicare is bankrupt, this change presumably doesn’t ever merit a fiscal asterisk.

And I suppose you could use this story to make a point about why, in a sensible health care system, voluntary medical procedures should be paid directly by the consumer rather than via insurance (though if private insurance companies want to offer that coverage, it’s not my business to object).

In my opinion, though, this story belongs in the “human rights” category because the policy apparently was made on that basis.

Now, time again for some libertarian commentary.

As far as I’m concerned, people should have the right to choose this type of surgery. Indeed, I personally know a great economist who has undergone this procedure.

All I’m saying is that other people shouldn’t be coerced to pay for it.

Which also describes my views on aspirin purchases, dermatologist appointments, and other health costs as well.

See, isn’t it great to be a libertarian! You don’t coerce other people and they don’t coerce you. Instead, you have a peaceful society based on voluntary cooperation and exchange.

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Last year, I showed an image of evolutionary stages that was so accurate that it would earn approval even from many strict creationists.

Here’s a new image of evolutionary stages that sets the stage for today’s discussion. Simply stated, Americans are becoming bigger. In some cases, a lot bigger.

Is this trend toward greater obesity a bad thing? As a reader asks, is it something that requires a government response?

The answer is yes…and no.

Libertarians believe people should be free to make their own decisions so long as they’re not infringing on the rights of others. And that includes the right to eat too much and exercise too little.

But the “yes” part of the answer is that we can think obesity is unfortunate and we can encourage our friends and family members to live healthier lifestyles. And if we’re willing to be pests and to run the risk of being told to mind our own business, we can even encourage strangers to shape up.

The “no” part of the answer refers to whether the government somehow should get involved. I shared a great video from Reason TV several years ago that explained why paternalistic anti-obesity programs don’t work. And just this week, one of my colleagues at the Cato Institute, Michael Tanner, addressed this issue. Here’s some of what he wrote for National Review.

Recently the American Medical Association declared that it will consider obesity a disease. …the AMA’s move is a symptom of a disease that is seriously troubling our society: the abdication of personal responsibility and an invitation to government meddling. …the AMA’s move is actually a way for its members to receive more federal dollars, by getting obesity treatments covered under government health plans. A bipartisan group of congressmen has already seized on the AMA declaration as they push for Medicare coverage of diet drugs. Observers also expect an effort to expand Medicare reimbursement for bariatric surgery, a.k.a. stomach stapling. And there will almost certainly be pressure to mandate coverage for these things by private insurance carriers, under both state laws and the Affordable Care Act. …After the AMA decision, John Morton, treasurer of the American Society for Metabolic and Bariatric Surgery, was almost giddy, calling the AMA decision a “tipping point” and adding that “now coverage policy must catch up to that consensus.” Since a typical bariatric surgery costs as much as $40,000, that could be interpreted as a warning for all of us to get out our wallets. In the end, we will be paying more, through either taxes or higher premiums.

And don’t forget that the price of treatments such as surgery almost surely will climb as there’s more “third-party payer,” so our taxes and premiums will climb by a lot more than what it cost to provide these services today.

But that’s only part of the story. Since government is picking up the tab, that gives politicians a green light (at least in their minds) to pass laws and rules designed to control and influence our behavior.

…expanded Medicare and insurance coverage socialize the cost of treating obesity, thereby inviting all manner of government mischief. After all, if being fat is not our fault, the blame must lie with food companies, advertising, or other things that need to be regulated. And if you and I have to pay for the food and exercise choices of others, we should have a say in those choices. Already, Harold Goldstein, executive director of the California Center for Public Health Advocacy, has cited the AMA declaration to boost his group’s efforts to ban junk food and tax soft drinks. …The nanny state can now claim medical backing.

Mayor Bloomberg doubtlessly thinks this is a wonderful idea. Maybe he can ban snack food as well as 17 oz. sodas.

Heck, why not have a cop in every house to make sure we consume 5 servings of fruits and vegetables every day? Actually, I shouldn’t say that too loud. Given the Supreme Court’s Obamacare decision, there’s apparently no limit to the federal government’s power to control our behavior through the tax code, so I’d hate to give politicians any more crazy ideas.

If you think I’m engaging in a bit of hyperbole, just remember that New York City already has gone after bake sales for peddling sweets.

So what’s the big picture? Mike nails it, explaining that the medicalization of obesity is symptomatic of the effort to undermine individual responsibility.

Much of public policy these days seems designed to eliminate personal responsibility. Take efforts to reduce poverty, for example. How much of poverty is due to poor lifestyle choices? We don’t want to blame the poor, nor should we forget that there are those, especially children, trapped in poverty by circumstances beyond their control. But we also know the keys to getting out of or staying out of poverty: (1) finish school; (2) do not get pregnant outside marriage; and (3) get a job, any job, and stick with it. Unfortunately, much of the welfare state we have constructed is perversely designed in ways that end up encouraging destructive behaviors.

In other words, the welfare state hurts the poor, as Thomas Sowell explained the other day. Though I suppose fairness requires me to admit that there are those who benefit from all the various income-redistribution programs. A vast army of bureaucrats get very comfortable salaries to administer these program, and these poverty pimps, as Walter Williams describes them, enjoy much higher levels of compensation than they could earn in the economy’s productive sector.

But I’m guilty, once again, of digressing. Let’s get to the rest of Mike’s final point.

Big government reduces all of us to the status of children. We have no responsibility for anything in our lives; therefore, government must take care of us. All we have to do, like children, is give up the freedom to make our own choices — good or bad.

Amen. A “good choice” isn’t good if it’s the result of coercion. Paternalists sometime have admirable goals, but they err when they want to turn big government into big daddy and big mommy.

P.S. Several readers have noticed that I’m now writing one post a day instead of two and have asked whether this is a permanent change. The answer is yes. With all the other things I’m trying to juggle – researching and writing, dealing with Capitol Hill, talking to the press, giving speeches, etc – this seems like the best way to allocate my time. Particularly now that my posts tend to be a lot longer and more substantive than when I began blogging.

P.P.S. Since we’re on the topic of obesity, it goes without saying that our real problem is bloated government, not bloated people. Which is why I always enjoy cartoons that portray DC as the true home of gluttony. For good examples, see here, here, hereherehere, here, here, here and here.

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Back in 2009, I wrote about various schemes to impose taxes on unhealthy food. At the time, I was primarily concerned about the risks of giving politicians a new source of revenue that would be used to increase the burden of government spending.

The folks at Reason TV look at the issue from a different angle and explain how government anti-obesity efforts won’t achieve their supposed goals.

One of the frustrating aspects of this debate is that failure will be used to justify even more intervention (aka, Mitchell’s Law). Politicians in New York City have already banned bake sales, for instance, yet that didn’t stop Mayor Bloomberg from unleashing a nutty new plan to prohibit large sodas.

And as explained in the video, the statists will respond to the failure of current anti-obesity efforts by arguing they need even more power to control and tax. And when those new efforts fail, they’ll argue for additional authority. Lather, rinse, repeat.

P.S. I assume this cartoon was designed to show why a value-added tax is a bad idea, but it’s very appropriate for this topic as well.

P.P.S. This issue helps explain the dangers of government-subsidized healthcare. Politicians make taxpayers pick up the tab for other people’s medical expenses and then claim that they should have the power to regulate private behavior in order to reduce costs.

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I try to visit the Drudge Report  once a day because he has a knack for finding quirky stories. One of his recent gems is a report from the UK-based Sun about an obese man who is suing the government’s healthcare system because he got close to 1200 pounds (assuming I’m right about a “stone” being 17 lbs) before getting weight-loss surgery. [CORRECTION: A "stone" is 14 lbs, so he was close to 1000 lbs]

Man mountain Paul Mason plans to sue the NHS – claiming they ignored his plight as he rocketed towards 70 stone. …Paul said: “I want to set a precedent so no one else has to get to the same size….” At his heaviest Paul was eating 20,000 calories a day – ten times what a normal, healthy man should consume – and the cost of caring for him is thought to have hit £1million in 15 years. …He finally had the £30,000 operation last spring but before it could take place floors at St Richard’s Hospital in Chichester, West Sussex, had to be reinforced at a cost of £5,000 to take his weight.

I’m not a fan of Britain’s wretched health system, but my immediate instinct is to take the side of the NHS and make some snarky comment about personal responsibility. Perhaps, for instance, we should ask Mr. Mason whether a government official was holding a gun to his head and forcing him to eat an average of 20,000 calories every day?

But that’s too easy. So I got to thinking about the public policy issues involved, particularly in the context of second-best solutions. In other words, if I’m not allowed to assume an ideal policy such as the dismantling of the National Health Service and restoration of a genuine free market, how would I deal with the issues raised in this story? There are two difficult questions we have to decide.

The first quiz deals with how to spend taxpayer money, combined with a bit of moral hazard analysis. Which option would you pick?

A. The NHS should have given him the operation right away to save money for the taxpayers in the long run. The operation cost nearly $50,000, but he was already costing taxpayers (I assume) $100,000 every year. Sounds like a smart investment that will pay for itself in just a few years.

or:

B. The NHS should not have given him the operation at all because that is akin to forcing taxpayers to subsidize personal irresponsibility.Moreover, it sends a signal to others that it will be marginally less costly to engage in similar self-destructive behavior. Last but not least, taxpayers probably will still pay through the nose to subsidize Mr. Mason’s annual expenses.

Our other quiz is about Mr. Mason’s lawsuit. As noted above, part of me thinks this case has no merit, but the article notes that it took five years before the NHS got him in the operating room after an initial surgery was canceled. In other words, it appears the lawsuit is happening because of the incompetence and waiting lines of a government healthcare system, so the real issue is the remedy. Which option would you pick?

A. Mr. Mason should win the lawsuit, both to compensate him for the government’s presumed incompetence and to punish the NHS for being so inefficient.

or:

B. Mr. Mason ate his way into trouble, so doesn’t deserve to win his lawsuit. Regarding the NHS, it is horribly inefficient, but any court-imposed damages would just get passed on to taxpayers, so there’s no possible upside.

So how do I answer these questions, assuming the Sun reported all the relevant facts and did so correctly?

For the first question, I reluctantly pick A. I’m guessing that the surgery will somewhat reduce the long-run burden that Mr. Mason is imposing on taxpayers. I realize there’s a genuine moral hazard issue, and that decisions like this make is marginally easier for other people to become morbidly obese (and thus impose costs on taxpayers), but my gut instinct is that surgery is still the best choice from a cost-benefit perspective. Finally, even though I’m not overflowing with sympathy for Mr. Mason, I’m a sucker for happy endings and maybe this will turn his life around.

For the second question, I do realize that governments should not be immune from lawsuits. And I say that even though it galls me that taxpayers pay for any damages awarded, either directly or because tax dollars are used to purchase insurance policies (it would be much better if successful lawsuits meant that damage awards were financed by cuts to agency budgets and/or reduction in bureaucrat pay, but I’m only allowed second-best solutions here). Nonetheless, I still pick B, and I make that choice with a decent degree of confidence. My decision is based two factors. First, I don’t want taxpayers to pay even more just because the government is incompetent. In many cases, that might not matter, but now we come to the second key factor, which is that Mr. Mason’s problems are self-inflicted.

To be sure, a court might be bound by the law rather than what’s right and therefore rule differently, but we already know from a previous blog post that I’m not similarly constrained.

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