"Fat tax?"

[Miami_med]

The problem is the view that we should control what people do to themselves. Someone who eats too much hurts himself. If he chooses to hurt himself, that is his perogative. My problem occurs when we start to argue that we should feel morally obligated to pay for the treatment of the person. If people smoke, let them. It is our duty to educate, but it would be a horrible system where doctors tried to mandate health. That flies in the face of any semblance of freedom.

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[deleted87716]

We're only bankrupting the country because we insist on paying for people who make stupid decisions.

If he chooses to hurt himself, that is his perogative. My problem occurs when we start to argue that we should feel morally obligated to pay for the treatment of the person.

So, you're saying we shouldn't try to prevent people from doing things that make themselves ill, but instead we should refuse to take care of their illness?

Morally, ethically, or whatever...that's an even bigger can of worms, IMO.

 

[Faebinder]

You have to coax them to stop smoking not just because of them being harmed... second hand smoking is as bad as first hand smoking... This is not some cocaine addiction that only harms the person addicting usually (or the person they are robbing for the money for the coke.)

 

[Miami_med]

So, you're saying we shouldn't try to prevent people from doing things that make themselves ill, but instead we should refuse to take care of their illness?

Morally, ethically, or whatever...that's an even bigger can of worms, IMO.

I believe that you are misunderstanding me. I believe in personal responsibility, but I am not against education. As a physician, I hope that I will be able to educate my patients as to the wisest course of action. I hope that I can be persuasive. However, I do not believe that the government should MAKE them do things that are healthy. This is their personal decision in a free society.

Now, I will talk to them, push them, educate them, and possibly plead with them, but I cannot make them. I want to help as much as the next guy, but I don't think that getting uncle sam involved in what people choose to eat is the right answer. Also, if these people refuse to listen to common sense, I do not believe that my, or anyone else's, money should be forcibly confiscated through taxation in order to provide care for ailments that they knowingly refused to prevent. They will have the right to seek treatment, and I firmly believe in doing my best to help those who can't help themselves. This is my PERSONAL CHOICE, and it is not being imposed upon me. Again, I believe in personal responsibility. I do not believe in a paternalistic model of government or medicine.

 

[deleted87716]

I believe that you are misunderstanding me...if these people refuse to listen to common sense, I do not believe that my, or anyone else's, money should be forcibly confiscated through taxation in order to provide care for ailments that they knowingly refused to prevent.

I don't think I'm misunderstanding you at all.

Education aside, you're neglecting the fact that for many (if not most) people, not paying for care is equivalent to not providing care.

In the unemotional realm of rights and responsibilities, such a concept may appear just, but it's also impractical.

I do not believe in a paternalistic model of government or medicine.

"Paternalism" comes from the word "father." Just as most of us wouldn't have gotten where we are without the guidance and wisdom of our fathers or father figures, society likewise demands a certain amount of paternalism from its leadership. The real trick lies in finding the right balance.

 

[iatrosB]

It begins:

http://news.yahoo.com/s/ap/20060927/ap_on_he_me/diet_trans_fat_ban

 

[Miami_med]

I don't think I'm misunderstanding you at all.

Education aside, you're neglecting the fact that for many (if not most) people, not paying for care is equivalent to not providing care.

In the unemotional realm of rights and responsibilities, such a concept may appear just, but it's also impractical.



"Paternalism" comes from the word "father." Just as most of us wouldn't have gotten where we are without the guidance and wisdom of our fathers or father figures, society likewise demands a certain amount of paternalism from its leadership. The real trick lies in finding the right balance.

Then you can give them whatever you wish. My father didn't have to take things from other people to impart wisdom to me. Wisdom doesn't equal taking from one to pay for the mistakes of another. Wisdom doesn't equal taxing people out of their hard earned money so that they can be poor and fat. The sheriff makes a poor Robin Hood.

 

[iatrosB]

Then you can give them whatever you wish. My father didn't have to take things from other people to impart wisdom to me. Wisdom doesn't equal taking from one to pay for the mistakes of another. Wisdom doesn't equal taxing people out of their hard earned money so that they can be poor and fat. The sheriff makes a poor Robin Hood.

I'm getting a vibe that you are interested in healthcare and economics

 

[lwestfall]

I too think it's important to educate people and let them make choices and reap their own consequences - but the state of food education out there in the general population is truly abysmal right now, and it would take massive public health education funding to compete with all the unhealthy advertising so pervasive in our current crap-food culture/society. So instead of waiting for people to get educated as they become more and more sickly, I can certainly see a place for using government regulation to protect people from their ignorance, at least as a stop-gap until we can ensure the education is there.

How about limiting food stamps to non-prepared foods only? No twinkies, no sodapop, no icecream, no chips.....

You want to eat saturated fats? Work for it.

This is exactly what I've been thinking for a while! Seriously, the people on food stamps are maybe the most sickly chunk of the population (and hence a disproportionate burden on our healthcare system), so why give them money for nutrition-less soda, chips, oreos, and candy to fatten them and their kids up and make them even sicklier? If the point of food stamps is (I would hope) to help the poor keep nourished and healthy (and thus able to contribute to society rather than burdening it further), then food stamps should only cover highly nutritious foods - "non-processed foods only" is certainly one approach.

So what group out there would/could lobby for this? (And I assume this would be at the state level?) I'd love to hear some ways we could channel all this discussion into some positive action that might actually make a difference.

Thanks,
Lincoln

 

[Doc Oc]

Initially, the thread was about making bad food more expensive in an effort to curtail the unhealthy habit and thus lead to better health outcomes and decreased health costs, an effort similar to raising the prices of cigarettes.

Now, the topic seems to revolve around the choices that obese people make and whether or not we should pay for it, which is an entirely different issue.

I don't think obese people can all be lumped into the same category. Rare examples aside (athletes, etc.), people are overweight for different reasons, and its not so easy to just say they are all like that by choice. Sure, there are the PCOS, hypothyroid, chronic steroid users, antidepressant/antipsychotic takers, but they are a small percentage. The group that I think this discussion treats the most unfairly are those who have been obese since they were children, which is a significant percentage.

There seems to be an assumption that these people aren't trying, or never tried, or haven't tried twenty times and are sick of how depressed they feel when they try and fail again. Sure, some might not try, or may have given up completely. But I think that most would love to lose weight if they could figure out how to do it. It's not as easy as diet and exercise. We're talking millions of obese people here, living in a society that glorifies the fit human body. Some might disagree, but there's just not millions of stupid, lazy people walking the earth who can't figure out how to eat less and move more.

So, when refusing care (which is essentially what you'd be doing by not paying for it, KentW speaks the truth), how can one quantify who of the millions deserves this (non)treatment, and who was fed pizza and coca-cola too much as a child? Who weighs 200lbs because they are lazy, and who weighs 200lbs because they lost 40lbs and plateaued there? Who eats junk food because they like it, and who eats it because a big bag of Better Made potato chips for $1 is a helluva lot more food to snack on than one mango?

 

[Doc Oc]

I too think it's important to educate people and let them make choices and reap their own consequences - but the state of food education out there in the general population is truly abysmal right now, and it would take massive public health education funding to compete with all the unhealthy advertising so pervasive in our current crap-food culture/society. So instead of waiting for people to get educated as they become more and more sickly, I can certainly see a place for using government regulation to protect people from their ignorance, at least as a stop-gap until we can ensure the education is there.



This is exactly what I've been thinking for a while! Seriously, the people on food stamps are maybe the most sickly chunk of the population (and hence a disproportionate burden on our healthcare system), so why give them money for nutrition-less soda, chips, oreos, and candy to fatten them and their kids up and make them even sicklier? If the point of food stamps is (I would hope) to help the poor keep nourished and healthy (and thus able to contribute to society rather than burdening it further), then food stamps should only cover highly nutritious foods - "non-processed foods only" is certainly one approach.

So what group out there would/could lobby for this? (And I assume this would be at the state level?) I'd love to hear some ways we could channel all this discussion into some positive action that might actually make a difference.

Thanks,
Lincoln

I'm not sure where to start.

As a society that must coexist and thus be affected at least indirectly by what others are doing, I understand how some may feel the need to impose regulation on areas that were once personal freedoms of others (banning smoking in some public places, for example.) Changing policies with a beneficent purpose into a policy of non-malificence is a tricky area. Poor people get food stamps so that they can eat, not so that they can be healthy and hopefully lessen the effect of their existence on the rest of society. (I am so cringing right now.) One day, people decided that its just not right to let others starve, so they banded together to let the people eat. It's sad that the power to do good (feed hungry people) might be able to be used to take away liberties of those who are most vulnerable, meanwhile the rich people still get to eat cake.

 

[lwestfall]

Poor people get food stamps so that they can eat, not so that they can be healthy and hopefully lessen the effect of their existence on the rest of society.
... meanwhile the rich people still get to eat cake.

In sincere compassion for the poor, I honestly think that instead of just making sure they get plenty of calories (and food stamps can buy you LOTS of calories if that's all you're after) so that no one is "starving," we should be focusing on prevention and channeling the food stamps money toward HEALTHY nutrition of the poor. I see it as very counter-productive to spend tax dollars on stuffing the poor with crap "food" that in turn just creates more health problems to be covered by more and more tax dollars via Medicaid.

Lincoln

 

[lwestfall]

BTW, yes, I'm all for taxing crap "food" (and making healthful foods more affordable) for all buyers in an effort to stem the obesity epidemic, in much the same way we use cigarette taxes in the interests of public health. As long as that money would be used specifically for prevention/health education efforts.

Lincoln

 

[lwestfall]

taxing crap "food"

We could at least start with the main dietary contributors to obesity, like soda and white flour products. Sadly, that's a huge part of most people's diet. It goes back to the lack of education out there - most shoppers don't know the difference between "wheat bread" (which could be 100% white flour, but may have some caramel coloring in it to "look healthier") and "whole grain bread" (and even that has to be 100% whole grain to really mean something).

Lincoln

 

[Faebinder]

It begins:

http://news.yahoo.com/s/ap/20060927/ap_on_he_me/diet_trans_fat_ban

Did you guys check out the link posted by iatrosB.... check out this section.

McDonald's began using a trans fat-free cooking oil in Denmark after that country banned artificial trans fats in processed food, but it has yet to do so in the United States.

Translation: If a company is not force to feed humanity food that wont kill it, then it will not do so unless forced by some form of law.

After transfat I hope people go after high fructose corn syrup... that garbage is in everything from hotdogs/hambergurs to soda/juices. Is it a wonder we got an epidemic of diabetes?

 

[lwestfall]

Did you guys check out the link posted by iatrosB.... check out this section.

McDonald's began using a trans fat-free cooking oil in Denmark after that country banned artificial trans fats in processed food, but it has yet to do so in the United States.

Translation: If a company is not force to feed humanity food that wont kill it, then it will not do so unless forced by some form of law.

Sad but all too true.

After transfat I hope people go after high fructose corn syrup... that garbage is in everything from hotdogs/hambergurs to soda/juices. Is it a wonder we got an epidemic of diabetes?

Oh yeah, HFCS was the other thing I forgot to mention.

Lincoln

 

[DropkickMurphy]

Did you guys check out the link posted by iatrosB.... check out this section.

McDonald's began using a trans fat-free cooking oil in Denmark after that country banned artificial trans fats in processed food, but it has yet to do so in the United States.

Translation: If a company is not force to feed humanity food that wont kill it, then it will not do so unless forced by some form of law.

After transfat I hope people go after high fructose corn syrup... that garbage is in everything from hotdogs/hambergurs to soda/juices. Is it a wonder we got an epidemic of diabetes?

Hmmm.....how will they sweeten soda then? Just FYI.....If anyone is depraved enough to go after caffeine and I think we'll see a second civil war. It happens to be my and several million other peoples' drug of choice.

 

[iatrosB]

Just FYI.....If anyone is depraved enough to go after caffeine and I think we'll see a second civil war. It happens to be my and several million other peoples' drug of choice.

There would be the biggest black market ever for that stuff! You'd have "caffeine labs" springing up in every other basement

 

[razorback831]

Initially, the thread was about making bad food more expensive in an effort to curtail the unhealthy habit and thus lead to better health outcomes and decreased health costs, an effort similar to raising the prices of cigarettes.

Actually, and it is probably a moot point, I said that those who were healthy/fit could get some income tax benefit/break.....somewhere along the lines it deviated from there

 

[Doc Oc]

In sincere compassion for the poor, I honestly think that instead of just making sure they get plenty of calories (and food stamps can buy you LOTS of calories if that's all you're after) so that no one is "starving," we should be focusing on prevention and channeling the food stamps money toward HEALTHY nutrition of the poor. I see it as very counter-productive to spend tax dollars on stuffing the poor with crap "food" that in turn just creates more health problems to be covered by more and more tax dollars via Medicaid.

Lincoln

I still think it is unfair to tell people what they can and can't eat - which is what you are doing to those who rely on food stamps to put any food in their mouths. So perhaps something where food stamps are worth more if they are spent on healthy foods, ie a coupon is worth 80cents on a bag of chips, but 1.50 if spent on chicken breasts. But to ban junk food from a segment of the population because of where they were born is an invasion of personal rights, and in effect, discriminatory because the method of regulation doesn't apply to the whole population.

I agree that the unhealthiest foods are the cheapest. The cheapest foods that give you the largest amount tend to be off-brand white bread, drumsticks, big bags of potatoes, plain potato chips, sales on canned food, and Ramen noodles. In the fall, there are good deals on apples. But forget having fresh organic vegetables, seafood, and whole grains on the table every night, it's just not going to happen with the way prices are.

I stand by if you are doing something nice for someone, the primary purpose should be to benefit that group, not the groups around them. Food stamps are already limited to certain items in the grocery store, can' t be used for fast food, and have other limitations on them as well. You can't just buy whatever you want with them. Items that are deemed too expensive and unnecessary are not included in the program. Certain fruits and vegetables are banned too (for example, red peppers are $4 a pound while green are $1 a pound, so red are banned and green are ok) I don't know the exact vegetable rules, but I have seen people have to put back vegetables before.

 

[lwestfall]

So perhaps something where food stamps are worth more if they are spent on healthy foods

Yeah, I think that would be a good thing.

I stand by if you are doing something nice for someone, the primary purpose should be to benefit that group, not the groups around them.

Yes, I think that's important. The other thing is that the food stamp monies are resources allocated to help these people, and it's really a shame when those resources get wasted on cartloads of sugar food. And this does happen - I've talked with poor working-mom food stamp benefactors working at the cash register who were saddened at the countless times they've seen counterparts using their food stamps on tons of candy and sugary snacks for their kids but nothing healthy.

I think it's kind of similar to how it's sad to see limited health care resources being wasted on certain unnecessary expensive workups or heroic yet futile end-of-life procedures (e.g. because the patient or family wants "everything" done), where those resources could have been used to help other patients for actual benefit.

Thanks for the interesting discussion,
Lincoln

 

[DropkickMurphy]

There would be the biggest black market ever for that stuff! You'd have "caffeine labs" springing up in every other basement

It's one of the few compounds easier to produce than meth. And you don't have to steal anhydrous to do it.

If there were to be a ban on caffeine, I imagine you would see a major jump in murders, assaults and road rage for a few weeks after the ban went into effect....

 

[sophiejane]

If there were to be a ban on caffeine, I imagine you would see a major jump in murders, assaults and road rage for a few weeks after the ban went into effect....

Not only that, people would start failing out of medical school (I know caffeine was the secret to my success!), so there would be no one to sew them up....

 

[Miami_med]

I'm getting a vibe that you are interested in healthcare and economics

Am I that obvious?

 

[deleted87716]

More on the concept of a "fat tax" from Britain: http://www.medpagetoday.com/PrimaryCare/DietNutrition/tb/6143

In a mathematical model based on British data, a fat tax levied on unhealthy foods could avert about 2,300 deaths a year in the United Kingdom, according to Oliver Mytton, M.D., of Queen's Medical Centre, here.

The benefit would come mainly from reducing salt intake, Dr. Mytton and colleagues reported in the August issue of the Journal of Epidemiology and Community Health.

But another model -- in which the target was foods high in saturated fats -- showed that a fat tax might actually increase cardiovascular deaths, the researchers said.

"Taxing foodstuffs can have unpredictable health effects" if all the supply and demand interactions aren't taken into account, Dr. Mytton and colleagues said.