AP: Do penalties for smokers and the obese makes sense?

The estimated annual health care costs of smoking/obesity are a combination of junk science and junk economics — i.e., if you smoke and you get sick or die, then your sickness/death is assumed to be entirely attributable to your smoking. Moreover, end of life costs add up for virtually everyone.

“Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures. But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers’ estimates.” [Associated Press]

22 thoughts on “AP: Do penalties for smokers and the obese makes sense?”

  1. There is one major issue with this argument. Smokers do not cost any more than non smokers. That is because they die sooner than theri non smoking counterparts. (NEJM) Another study showed that healthy 65 year olds will cost as much or more than unhealthy 65 year olds. Again, the healthy patients live longer and end up consuming just as much health care.

  2. Using this logic we should bad skiing , scuba diving, mountain climbing or any other activity where there is a risk you can get hurt and impart higher costs on the health care system. I don’t like smoking but people should be free to live their lives and risk them as they see fit, otherwise who’s to say what gets banned next.

  3. If the risk of smoking is as bad as were told, then the money saved with regards to old age pensions would be far grater than any temporary health care costs.

  4. Peter | January 26, 2013 at 10:50 pm | Reply
    Using this logic we should bad skiing , scuba diving, mountain climbing or any other activity where there is a risk you can get hurt and impart higher costs on the health care system.
    jk——-Yep. All that is coming to save money. Also need to ban bikes as dangerous transportation.

  5. Government by jerks. They insist on picking up the tab, then complain about how much it costs.

    RexAlan adds an important point: early death saves not only health care cost, but also Social Security, etc.

  6. Statistics by data dredge and inappropriate use of correlation? I’ve never been convinced the statistics sort out confounding causes or just say add the “smoker” and/or “obese” tag to the death. Do they have a category of “obese smoker” that is twice the predicted life expectancy decrease? Diseases like type 2 diabetes are associated with obesity and are often “cured” by a diet resulting in weight loss. The common factor is diet. Obesity and diabetes would seem to be are the results of dietary choice and genetics(?).

    How is the government going to pay for SCHIP when they stop people from smoking? Once they get the desired population of thin, non-smokers will they decide that people suffering from MBS (multiple birthday syndrome) cost too much?

  7. I agree the smoking data is really cloudy and the obesity data is very slim. Not all people who smoke get lung cancer and data shows that people carrying extra weight are healthier than those who carry too little. Type 2 diabetes can improve with weight loss, but not for everybody. Much of the obesity data is poorly extrapolated by looking at a number of about 1 to 2 thousand patients in a corner of this country and extrapolating out over the 300 million population. Even the definition of obesity is poorly based on a height/weight BMI. This does not corollate well with percentage of body fat. Every professional Football player is morbidly obese by this calculation.

    As a Doctor the question I pose is this. Is health care a Right or a Privilege?

    If it is a right than who is it that can modify that right? Do we “punish” those who we perceive are not exhibiting behavior’s in regard to their personal health that we don’t like? Do we limit their care in some fashion until they behave as we feel they should and look the way we wish them to? At one time or another we all commit atrocities of poor decision making when we consider our own healthy choices. Too many ideas change over time in health care as we understand more. Many examples exist what was once considered unhealthy turns out to be the opposite and visa versa. I shudder at the future policies that will be decided in a closed unapproachable room (Like the Fed) that will not just affect a few but all of us. As Tom Daschle said in his book, Critical Care, ” No longer can physicians be autonomous in their decision making.” Which means care will not be decided between a Doctor and a patient but by a bureaucracy .

  8. “Is health care a Right or a Privilege?”

    Health care is the labor or property of others. One cannot have claims on the labor or property of others. Hence, health care is a privilege.

    Sorry if I responded to a rhetorical question.

  9. It has implications beyond the rhetorical. It’s “ok” to answer. Most physicians I know think it is a privilege. Yet the current populace believe it is a right.

  10. “They insist on picking up the tab, then complain about how much it costs.” That’s exactly what has happened in UK in particular. Also, smokers have been paying “sin taxes” almost as long as cigarettes have been sold in packs and that was supposed to cover their healthcare. Not to mention some insurance policies charged higher premiums for smokers. And then there was the tobacco settlement that was supposed to reimburse states for the Medicaid costs of smokers. A lot of this has gone on.
    Everyone dies. Unless we die suddenly, most of us want at least palliative care and most of us will try for definitive care to have more time for our families, more time to earn money, more life. Imagine that. Most people will spend half or more of their lifelong healthcare costs in the last year of life, regardless of their previous health conditions.
    And the ones who don’t are either the ones who do die suddenly, as in traffic accidents, or the ones who are lingering with age-related diseases.

  11. Howdy Dr Paul and Gamecock
    Healthcare is neither a right nor a privilege. It is an economic activity like food or housing or transportation. As Gamecock notes, it requires the labor and property of others to provide healthcare services.
    Rights are negative in that no one may block you from exercising them. The right to free speech, to travel as you choose and can afford to, to enter the occupation you choose and for which you qualify — no one has any authority to block these things. Healthcare is a right like groceries are a right — all should have an equal right to purchase them with their own resources regardless of race or gender or age or personally distasteful habits.
    But I haven’t figured out where anyone has a right to demand healthcare without performing service to earn it, any more than anyone has a right to demand housing without … oh, crud, there’s HUD, isn’t there? Food stamps. TANF.
    Poverty aid should be mostly a matter of charity, not taxation and therefore compulsion, and that includes healthcare. Some people can pay for their own and most of us need to make provision. An insurance plan seems the best way and the one most supportive of liberty and economic sense.

  12. Howdy dr22
    I do live in the modern world. Like William Buckley, there are parts of it where I want to cry “Stop!” When “charity” and “generosity” consist of legislators taking money from some to pay for the needs of others, rather than in people freely giving to relieve the needy, we need to yell “Stop!” at the voting booth. When you’re generous with other people’s money, you’re not generous.

  13. There are several critically important pieces of information that were left out of this story, perhaps because they would be so unsettling and surreal to readers, but people deserve to know what is happening.

    This story and a number of news stories last week came from a press release (calling for stronger government laws and regulations and for vigorous stigmatization of fat people, patterned on the anti-smoking campaign) from Hastings Center. [http://www.eurekalert.org/pub_releases/2013-01/thc-blc012213.php] It is propaganda and demonstrates that junk science can be deadly.

    They are trying to desensitize people and get them to believe and used to the idea that letting certain people die is actually a credible and ethical idea – and that they cost more and waste public healthcare dollars and don’t deserve saving. Their premise about obesity is false, first of all. Credible medical research for decades has proven it is primarily genetic and a marker of aging, not bad behavior. Nor are fat people inherently more likely to die or be diseased (when controlling for key confounding factors), as the CDC scientists and others have been reporting for the past decade. But fat people and smokers aren’t their only targets.

    What wasn’t revealed is that the doctors and scholars in the article are leaders in the American eugenics movement. Daniel Callahan, founder of the Hastings Center and president emeritus, was on the board of directors of the American Eugenics Society from 1987 to 1993 and S. Jay Olshansky (he’s the guy who terrified children by saying that if they were fat they would die before their parents – a claim he made up and has since been discredited, but continues to be repeated) is the current president of the American Eugenics Society.

    Hastings Center promotes euthanasia and eugenics and all the key American eugenicists are or were associated with it. Be careful because eugenics was renamed “bioethics” years ago to make its core missions more transparent and they discuss issues euphemistically and with a feigned scholarship. You’ll see terms like “palliative care,” “duty to die advances,” “right to die,” and “population control.” They are all advocates of the Futile Care Theory, also called the Complete Lives System, which promotes denying medical care to the elderly, sick and poor, and rationing care based upon a person’s usefulness or value to society and the public common good (“social justice”).

    Callahan is a prolific writer, such as the book Setting Limits which said the government should refuse to pay for life-extending medical care for people beyond age 70-80, and only pay for palliative care aimed at relieving their pain, and let them die.

    Another Hastings associate, for example, is Hastings fellow, Ezekiel Emanuel who serves as the director of the Clinical Bioethics Department at the U.S. National Institutes of Health, was a key creator of Obama’s healthcare reform plan and his bioethics advisor. He was a lead member of the government’s Comparative Effectiveness Research, which included other Hastings associates. “Comparative effectiveness” does NOT mean looking at the most effective and quality of medical care, it means deciding the allocation (rationing) of medical resources based upon a person’s usefulness or value to society and the public common good. He wrote a paper in the journal Lancet [http://www.ncpa.org/pdfs/PIIS0140673609601379.pdf] that described how rationing decisions under government healthcare will be made based on the value of a complete life and the “future usefulness” of a life and those who will use fewer resource. It rejects first those who are sick and elderly. See the graphic that shows how babies and people older than late 50s should receive less medical resources based on the complete lives concept.

    Their work has been frighteningly effective in moving governmental policy and even changing the definition of medical ethics, and even removing the hypocratic oath. [http://junkfoodscience.blogspot.com/2009/07/todays-changing-medical-ethics-where.html] Upon taking office Obama fired the old President’s Council on Bioethics and appointed a new commission based on these new ideas of medical ethics.

    The US government now forces every citizen at retirement age into government managed care, Medicare. The only way to opt out is to relinquish all of the social security benefits you’ve paid into your entire life. The first proposal from the administration to “save healthcare costs” was to cut $313 billion from Medicare, which cares for seniors and disabled people. Didn’t anyone wonder how they really proposed to do that?”

    By the way, did you catch another Hastings Center press release issued last week calling for a complete overhaul of medical ethics and for a new ethics for medical research be adopted? [http://www.eurekalert.org/pub_releases/2013-01/thc-epo012313.php] It said: “The longstanding ethical framework for protecting human volunteers in medical research needs to be replaced.” Frightening. Remember, the lessons of the Nuremberg Trials formed the core of today’s medical ethical guidelines and protecting people during human experimentation. [http://junkfoodscience.blogspot.com/2008/06/medical-ethics-retrospective.html]

    A few articles that may be of interest on what’s happening:




  14. Really. In medicine it has the most statiscally flawed data of any science. While you can examine a thousand bolts in a box by randomly selecting a few. You know that every bolt went through a similar process in its formation. If you examine one thousand people they will all be genetically, socially, culturally, etc different. Draconian policies that attempt the one-size fits all attitude will work for some, do nothing to others, but will eventually harm a third group. The statistics are never a cause and effect nor can they be. They only are correlative at best in the real world. All factors that effect a person can never be truly accounted for. There is a strong correletive data that associates smoking to lung cancer but it is not a cause an effect no much how hard you may want it to be for each individual. (Look at cancer rates for smokers prior to the mid 1950’s)

    Doctors have take care of individuals not statistics.

  15. You’ve now validated my real concern. Thank-you for the follow-up. At what point is an individual rights vs societies rights are put at odds? Who determines who’s right take precedent? The world has been down this path before. Jews and Eastern Europeans were the victims in that debacle. Siberia and graves in Russia taught another lesson. The forced farming communes in China also fall into this . Now do we have to repeat the same lessons? Or am I just being an alarmist?

    Life is a precious gift. Now we have emotionally run animals with a vast intellect arguing otherwise for those who do not conform to the “ideal.”

  16. How about penalizing the tobacco industry and the FDA for producing and approving a product that was known to be highly addictive and toxic from the beginning to the unknowing public.

  17. Howdy Ruby
    First Americans used tobacco for something like five thousand years before Europeans met them and acquired a taste for it. That was in the 16th and 17th centuries, when most people died of infections or injuries long before cancer could develop.
    Doctors wondered if tobacco was safe for a long time but many of the crusaders against tobacco were also crusaders against liquor and meat and self-abuse, as it was called, so they had credibility problems.
    By the time people lived long enough to show that tobacco caused long-term health problems for many users, tobacco was thoroughyly entrenched in Western cultures and many others. During my own lifetime we’ve seen tobacco become a legal vice and a form of rebellion rather than the cool privilege of adulthood that it was for my parents and their generation. All of that was long before the FDA was even a concept.
    Tobacco companies were in no hurry to be branded as purveyors of death — who would be? But it’s quite unfair to accuse them of knowing from the beginning that their product was dangerous because it simply isn’t true.

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