Sunday, June 7, 2009

Reality sets in...

From the NY Times, it seems that the architects of Obamacare are starting to realize that revamping American healthcare is going to be expensive. Who would have thought it? And now it's starting to dawn on Orszag et al that just soaking the "rich" isn't going to provide nearly enough cash flow.

Eliminating the tax exclusion on the value of health coverage provided by your employer (i.e. redefining health benefits as taxable earned income, thereby bumping many Americans into higher tax brackets) is probably too politically unpalatable to be implemented. But I like some of the other ideas. Why not institute a national sales tax on products that tend to negatively impact health? Raise taxes on snacks, sodas, and high fat content foods. Make alcohol more expensive. (You can buy a case of Busch Light for 12.99---less than 60 cents a brewski!) Legalize marijuana and tax the hell out of it. And what about this: make people submit their documented BMI (body mass index) on their W2 forms every April. If you fall into the category of obese or morbidly obese then you pay a corresponding penalty fee, to be applied toward the healthcare kitty. If we're going to undertake such a massive public investment, the individuals need to be held accountable...

12 comments:

WarmSocks said...

Making people pay extra if their lifestyle choices lead to increased disease risk and poor health is an excellent idea. Think about unintended consequences, though, of a "fat tax" based on BMI. It would be wrong to make people pay extra if their disease (ie Cushings) or treatment (ie prednisone) causes weight gain. People struggling with disease don't need the additional burden of being taxed extra, or missing out on a deduction, simply because they had the bad luck to get sick.

Joseph Sucher, MD FACS said...

BMI. Check ... I'll tentatively agree to that in spirit. But not to this notion of the so-called "sin" tax. Asking for this nanny state to abscond with more of my money is fraught with multiple problems. I would have not believed that you would even consider this a plausible idea. I understand where you are coming from, but I implore you to hear out my arguments and reconsider the trajectory that you have proposed.

First, this tax proposal essentially says "we (the government) think this stuff is bad, but hey... we don't really care as long as you can afford the tax". Either its OK or its not.

Second, my BMI is OK. I enjoy a QP with cheese and a beer (I have blacklisted Busch since the InBev takeover). So why do you tax me for my legal and responsible behavior? Is there some proof that eating and drinking any of these products in moderation has created this health care crisis?

Third, having government reap moneys from these "unhealthy" products places them in a position to actually want you to purchase more of these products. They want your money because they are trying to feed the pig budget that we've allowed them to grow! In seeking this short-term crutch, the government will become dependent on these taxes for long-term viability. How many taxes that have been created will ever go away?

Fifth. I would measure the success of this program by people adopting a healthier life-style. This would cause a decrease in demand for the products. That would result in a decreased tax revenue. This would happen long before the unhealthy people die, thus there won't be enough money to continue to take care of them.

Sixth. You will create a whole new bureaucracy to define what is a snack, a soda, fast food or whatever. Thanks... that will cost money too!

Seventh. This does nothing to address the gross negligent overspending of our government. Cut out the pork and you won't need to come out to tax everything.

Back to BMI. I would be willing to explore the concept of having a positive feedback mechanism for maintaining a low BMI. At least that measures (to some degree) healthy behavior and addresses the catastrophic problem plaguing the U.S. (obesity). But if this becomes a government imposed mandate (keep BMI < 26), then I can only see the tidal wave of people demanding free obesity surgery. Just as the government has subsidized digital converter boxes for TV's after mandating that all broadcasts go digital (because we all know that you have a right to watch TV).

People need to be held accountable for their own health. But don't give the government pigs more money. Please don't advocate for more taxation. Its time for the government to lower its BMI.

Joe

platensimycin said...

There are simply

no other viable alternatives.

Buckeye Surgeon said...

Sucher-
I write this from a purely pragmatist perspective. Health care reform is on the way. And it's going to cost a bundle. Rather than placing the financing burden entirely on the shoudlers of 5% of the American population, I think it's not unreasonable to expect those who stand to gain the most benefit from universal health care to have a little skin in the game. And taxing unhealthy products makes sense to me. If people make dietary modifications based simply on the increased cost of said products, the end presumptive result is that Americans will be healthier/less obese/less dependent on pharmaceutical and invasive procedures to compensate for their DM II, CAD, hypercholesterolemia, etc. So the net loss in tax income that would result from less use of unhealthy products would be offset by a reduced need for expensive health care interventions. It's a pipedream, I know. But I don't think it's outlandishly unreasonable.

Anonymous said...

Rather than just focus on the sorry state our health care system is in, there are some pragmatic tips from the "Old World" (link).

In such contrast, their healthcare systems just seem so...intuitive.

Brainy analysis aside (yes, we need them to formulate guidelines, but not to the point of tripping ourselves as we walk), what we need is genuine incentive to make the system better. Obama's team is striving specifically for such end. Otherwise, it'd be more or less like trying to use chopsticks to contain gallons of spilled milk. The reform, esp a reform of such magnitude, needs to be multi-directional.

Anonymous said...

Historically, what great accomplishment* didn't start up as a laughable pipe dream?

* personal & political alike

Frank Drackman said...

Good Start Buckeye, but you left off a few...

1: No HIV Meds/Treatment unless patient provides Notarized proof of infection by Blood Products or In Utero...OK, if you're Haitian we'll cover you...You can always pay with your own money though,,,

2:As a Big-10 follower you know BMI is notoriously bad at picking out the fatties...You'll have a whole bureaucracy handin out exemptions for Body Builders and Midgets... Just go by Body Fat %, no harder to measure than getting your Car Emissions checked, added beni of gettin all those lazy bastards who still slip under the BMI margin...

3: W-2?? Why pick on the people who actually work?? I'd double all Sin Taxes on those who can't provide a W-2..Might be a little tricky to actually implement...but they'll figure it out

4: Busch Light?? An aristrocrat...let me introduce you to "Milwaukee's Beast"...

Nick Dupree said...

I love the idea of Rush Limbaugh baying like a wolf on his show when he's slapped with the BMI tax!

Anonymous said...

It's an interesting trend [in America] for

cynicism* to become a must-have sign of the wise and the educated.

It's amazing how cynical and bullsh*tish America's intellectual top echelon has become.

* even better if it comes with some sound/partial/nonsensical understanding of the economy.

Anonymous said...

Which aspect of healthcare in US actually works?

Pockets of isolated successes aside, pharma isn't introducing new drugs at affordable prices; most insurance companies aren't much of "insurers" per se; hell, even the walking aids our elderlies use turn out to be poorly designed and manufactured.

Who dares to fall ill or even get old in the USA (if it ever is a personal choice)?

"REALITY sets in..." - you've got that right. There won't be an one simple solution for the vastly complex and interconnected [and heavily contested] problem, that's for sure.

Anonymous said...

Science (EBM, or so it seems, is going to be one of many driving forces that will shape the US healthcare system [reform] for the decades to come.

Does the need and existence of such "influential scientific advisory panel" suggest how "scientific" we are, or potentially how undecided, divisive and even closed-minded we are?

Medicine should be guided and driven by BOTH science and compassion, rather than economic and bureaucratic pressure. Would such insistence on EBM and EBM alone rule out the possibility of genuine placebo effect, for instance?

Anonymous said...

Certainly don't want medicine to be a "guess work" - certainly don't want it to evolve into a "cookbook medicine" (without being able to address patient's need on individual basis) either.

There is still much we need to learn about hospital and healthcare administration. In my opinion medicine and education should be society's equivalent of "immune privileged sites" - have their own check & balance systems BUT immuned from relentless market force.