Paying for health care and "healthy choices"

Matt Yglesias points out he doesn’t really think that raising sin taxes will reduce health care costs. And he doesn’t make that argument in the post in which I attributed it to him, although he does link approvingly to people who do.

As Matt Weiner notes in the comments to my post, I over-interpreted what Yglesias was saying — he was arguing that “sin taxes” are a desirable way to raise revenue to pay for health care, and may well improve public health in the bargain. I’m more skeptical than he is about the latter point, for reasons I reference in my original post.

But my real concern is an argument that shows up all over the comments to Matt’s post, and, somewhat more significantly, is implicit in such pronouncements as Obama’s preposterous claim during the presidential campaign that rolling back obesity rates to 1980 levels would save Medicare a trillion dollars.

That argument is that people get sick because of lifestyle choices, which means that being sick is your own fault, which in turn means that “forcing” me to pay for your health care means I’m being forced to subsidize your bad lifestyle. This argument isn’t completely false, but it wildly exaggerates the extent to which “bad” lifestyle choices are responsible for health care costs. (As I pointed out in the context of cigarette smoking, it’s not even clear that a healthy lifestyle produces a net health care savings to society in comparison to a less healthy one). And it’s fueling such dubious innovations as quasi-mandatory “wellness programs” for employees

In other words, the really invidious effect of this argument is that it provides yet another handy excuse for not socializing the cost of health care, since needing health care at all, in the most extreme version, becomes a “choice.” And it’s disturbing how many people buy into some version of that claim.