The case for a Nanny State

Ban on supersize soda: are we putting too much emphasis on soda, not portion size in general?
http://www.boston.com/dailydose/2012/06/20/ban-supersize-soda-are-putting-too-much-emphasis-soda-not-portion-size-general/jLgrFjbn77qYGe01JMV8xO/story.html

This is an interesting situation for me. It is clear that there are many reasons why the US has porked up over the last few decades and given the long-term (and high!) cost to society for being such blubber butts, I feel that there is a real place for government intervention. I am not sure, though, that politicians proposing random bans on things (remember the earlier ban on certain types of fats?) will have any benefit. It sends naive messages that small changes in isolation can have dramatic impacts and totally fails to address the system nature that has arisen over the years that has got us wedged into this situation today.

I support the idea that external-to-the-market forces (meaning government regulation) need to be brought to bear (the next post discusses this in greater detail) for the greatest good of society, but I think that the random and clearly politically motivated legislation is counter productive. There should be some sort of tax that makes it more expensive to engage in sub-optimal behavior (taxes on tobacco and alcohol are perfect examples), but also (as detailed in the next post) a restriction on advertising the products involved in the sub-optimal behavior. A delicate line to walk, for sure, and one impossible for politicians. We need an a-political public health board that can be kept immune from industry influence (hah! what a dreamer I am!) that can make binding decisions that are automatically implemented.

While I am fantasizing, I also want to win the lotto…

About Tfoui

He who spews forth data that could be construed as information...
This entry was posted in Government, Healthcare. Bookmark the permalink.

4 Responses to The case for a Nanny State

  1. neoschiz says:

    So I’m not sure exactly how to put this, so I must going to write as my brain works it out.

    I believe in ‘obamacare’ we now have a law that everyone pays the same amount for the same health insurance. Personally I feel that individuals who make poor health decisions should have to pay a higher fee. For me who stays relatively fit, eats well, and exercises, I don’t think I should have to pay the same (or pay for their additional costs) of someone who has sat on the couch for the last 30 years eating, drinking, and smoking. They made poor choices, they should have to pay a higher fee.

    I don’t know how you regulate or apply something like that. One individual who is over weight might be because of genetics and the other because of bad choices? If genetics is the cause of the weight problem, they shouldn’t have to pay more (pre existing condition?). But then every single overweight person will claim ‘its genetics’ and everyone will want to get tested.

    Maybe the solution is similar to what you mention and create a ‘sin’ tax for ‘bad’ foods. But I feel this is very gray. There are probably some foods out there that can be labeled as ‘bad’ (soda, high sugar treats like cookies, brownies, etc), but most foods are fine in moderation. Should there be a tax on things like olive oil? On one hand its ‘healthy’ but on the other its pure fat.

    • Tfoui says:

      In my personal opinion, the core of the problem is twofold. One, people are not required to be protected by some sort of catastrophic insurance and two (and probably most important), in the US we have this moronic employer-backed health insurance. No one expects your employer to pay for your car insurance, why the hell have we created a society that expects your employer to pay for your health insurance? In similar vein, everyone who drives a car is required to carry some sort of catastrophic insurance. It is those two events that have lead to our reasonably priced and reasonably useful car insurance. Oh, to take the analogy a bit further, no one expects your car insurance to pay for your oil changes either, so why should your health insurance pay for checkups and routine stuff? If society decides that poor women should have ready access to birth control, then the government _itself_ should provide that access, NOT require the health insurance companies (or employers) to pay for it. We have a totally fucked up situation that has evolved to produce excessive profits under political protection. This is one of the fairly rare cases where I feel it is reasonable to argue that simple changes can result in massive changes in the market place. I really like the idea of people being required to carry insurance, but because the insurance industry blocks attempts at producing a more sane alternative to our idiotic employer-backed system (I always get a wry grin whenever the teapartiers blather about repealing ‘Obamacare’, like the insurance companies will let the GOP do such a silly thing to their increased profits), lots of people can’t afford insurance policies made wildly expensive because of the endless politicking.

      My recommendation, like it matters, is to require everyone prove they have catastrophic insurance or pay a fine via a loss of any state or federal tax refund (sure that can be gamed, but not easily). Employers would no longer be tax exempt for employee’s insurance. The insurance industry can no longer block the formation of health care unions (like credit unions) or grouped policies. Keep the HSA to encourage people to save to cover their deductible. If people actually have to pony up out-of-pocket for routine medical expenses (as they do for routine maintenance for their cars), I promise you that each one of them will suddenly become highly aware of the cost of their medicines as well as the value of any outcome from a doctor’s visit.

      Simple little changes that are impossible to implement in our country. The health insurance industry is rich and powerful and very well organized. Even though on the surface one would expect something like this to get full support from the teapartiers and the GOP in general, ‘taint gunna happen since the teapartiers are, for the most part, idiots being led around by their prejudices and the GOP (and the Democrats!) are owned by the oligarchy that owns the insurance ‘biz.

  2. DaWei says:

    I’m 71. When I was 24 I discovered I had a congenital defect in one of my vertebrae. That cost me (and my partially-employer-paid insurance) a few K.

    My next trip to the doctor was when I was 54, a physical as a requirement for employment. Everything was fine.

    My last trip was an involuntary trip to the emergency room because I was a passenger in a vehicular accident. I was told I had a few cracked ribs, nothing to be done about it, and sent on my way.

    What should I be required to pay, or do? (Actually, at this point I’m covered by Medicare, which I’ve never used.)

    • Tfoui says:

      I would say you are lucky then. Minor changes in life and you might have had huge medical bills that you might still be digging out of even now. I expect that just like term life insurance and liability-only car insurance can be very reasonably priced, catastrophic health insurance can be very reasonably priced in an efficient market. That it isn’t today (except for young men, since a lot of dumb things they do actually kill them, thus no expense) is because of our highly dysfunctional system. Of course, lots of people will insist that they can’t possibly be the ones that need the insurance, that is the nature of people, which is why I advocate being coerced into getting covered. What I object to in ‘Obamacare’ is not the coercion, but that we are being coerced into buying a policy when we have almost no control over what the benefits are. Since the vast majority of people will remain on employer-paid policies, the incentive for insurance companies to compete for those policies will be little to non-existent and one of the problems with catastrophic insurance is you don’t know the quality of the coverage until you desperately need it, so the opportunities for fraud are immense.

      Right now society is still bearing the cost of insurance, but it is being paid by people who aren’t availing themselves of the care. Emergency rooms are either subsidised directly by tax dollars or by the higher rates (and thus higher premiums) of hospitals for those who can pay. I have no complaint about a public health care option, as long as, unlike, say, in Canada, people can purchase extra benefits. What I don’t like is the situation we have now where people who pay for the benefit (health care) have absolutely no incentive to make efficient use of it, because of the layers of abstraction preventing them from being able to influence the system.

      For instance, if I, as a covered individual, decide to get a cheaper, generic drug when I go to the pharmacy, do I get to keep the difference between that and the expensive alternative? Hell no, it is a benefit that accrues exclusively to the insurance company. However, if the money to pay for the drug came out of my pocket (in the old days that is exactly what happened, then the insurance company would reimburse you later, but everyone in the ‘biz realised that that lead to people being parsimonious with their medical dollars instead of profligate like they are today), you can be sure I would want to be positive that the new drug was worth the extra price. Extend this same philosophy to CAT scans, XRays, etc. you can see that if people actually started to have skin in the game there would be a huge change in the way medicine was done in the US, almost certainly to the detriment of the pushers of expensive medicine with little evidence of its efficacy.

      That is why I advocate the catastrophic policy that people have to own. The small concerns are paid directly out of pocket and any large concerns (what would have happened if your accident was worse?) would be covered by the policy, keeping hundreds of thousands of people out of bankruptcy each year (http://articles.cnn.com/2009-06-05/health/bankruptcy.medical.bills_1_medical-bills-bankruptcies-health-insurance?_s=PM:HEALTH).

Leave a Reply