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The government’s share of healthcare spending has been growing since the inception of Medicare and Medicaid in 1965.

The tax credits, exchanges, and medicaid expansion under the Affordable Care Act (ACA or “Obamacare”) have the Congressional Budget Office predicting that the share of healthcare spending that the government bears will grow.

Something to Consider: Lifestyle choices like obesity and diabetes lead to increased healthcare costs, and as the government takes on a bigger role in bearing those costs, does it have a duty to the taxpayer to discourage those behaviors?

Do you feel that such discouragement would infringe on personal liberties, and the taxpayer should bear these expenses? Or do you feel that the government has a mandate to manage these lifestyle behaviors for the sake of the taxpayer and fiscal soundness?

What are the implications and complications with either choice?

39 Comments

  • Jacob Bouvier, August 11, 2015 @ 12:38 pm Reply

    I’m sure it’s just a trick of the grammar, and may seem a very tiny nit to pick, but I’d like to point out that there’s strong evidence that diabetes is not a lifestyle choice. Type 1 diabetes certainly isn’t, there’s no evidence that it even might be. Type 2 diabetes has a strong correlation with obesity, but currently there are many people questioning the automatic causation that is assumed. (Here’s the talk I first heard about this from: https://www.ted.com/talks/peterattiawhatifwerewrongaboutdiabetes?language=en) This subject is admittedly rather personal for me, but I still feel it is worth pointing out.

    That being said, there is something to be said for obesity not being a lifestyle choice either, in a large portion of the population. There are lifestyle choices that can become factors in obesity though, and I assume that’s more what is being referred to here. That is a really tough question, when you take into account personal liberties. Where does my right to put what I want into my body end? Currently, at certain restricted drugs. Any sweeping changes would need to touch on the providers more than the individuals, and therefore would certainly infringe on the personal liberty of people who can (or need to) eat different diets than whatever is judged "the standard."

    If you could somehow individualize the legislation, or whatever other method is used for discouraging behaviors, you might set a better standard. But to do that would likely require either the individual or the government to shoulder even larger costs, for personal nutritionists and the like.

    • Chris McAdam, August 11, 2015 @ 12:50 pm Reply

      I suspect the government approach would be banning / discouraging behaviours that obviously were harmful… smoking heads up the list. The recent efforts to restrict soda sizes show the government will indeed try to influence behavior.

      If the taxpayer is responsible for picking up medical expenses then yes, the government does have an obligation to do what it can to minimize behaviors that my increase the risk of incurring medical expenses. We can debate what those behaviors actually are (and I agree that type 1 surely isn’t caused by behavior and type 2 may not be) but setting that aside, anything that surely does cause an increased risk to health ought to be taxed at the least, and discouraged loudly and forcefully under some circumstances.

    • Something to Consider, August 14, 2015 @ 3:46 pm Reply

      I really like this nuanced view at the question–thanks for sharing it.

      Thanks also for sharing the science about the correlation/causation problem in obesity and diabetes–that’s new to me (and possibly new to a lot of other people) and helpful.

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