New health debate: Should society let smokers, obese die?
NEW YORK — With the high cost of caring for smokers and overeaters, experts say society must grapple with a blunt question: Instead of trying to penalize them and change their ways, why not just let these health sinners die?
Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures.
But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers' estimates.
And attempts to curb smoking and unhealthy eating frequently lead to backlash: Witness the current legal tussle over New York City's first-of-its-kind limits on the size of sugary beverages and the vicious fight last year in California over a ballot proposal to add a $1-per-pack cigarette tax, which was ultimately defeated.
“This is my life. I should be able to do what I want,” said Sebastian Lopez, a college student from Queens, speaking last September when the New York City Board of Health approved the soda size rules.
Critics also contend that tobacco- and calorie-control measures place a disproportionately heavy burden on poor people.
Critics call these approaches unfair, and believe they have only a marginal effect. “Ultimately these things are weak tea,” said Dr. Scott Gottlieb, a physician and fellow at the right-of-center think tank, the American Enterprise Institute.
Gottlieb's view is debatable. There are plenty of public health researchers who can show smoking control measures have brought down smoking rates and who will argue that smoking taxes are not regressive so long as money is earmarked for programs that help poor people quit smoking.
And debate they will. There always seems to be a fight whenever this kind of public health legislation comes up. And it's a fight that can go in all sorts of directions. For example, some studies even suggest that because smokers and obese people die sooner, they may actually cost society less than healthy people who live much longer and develop chronic conditions like Alzheimer's disease.
So let's return to the original question: Why provoke a backlash? If one in five U.S. adults smoke, and one in three are obese, why not just get off their backs and let them go on with their (probably shortened) lives?
Because it's not just about them, say some health economists, bioethicists and public health researchers.
“Your freedom is likely to be someone else's harm,” said Daniel Callahan, senior research scholar at a bioethics think-tank, the Hastings Center.
Smoking has an obvious impact in the form of secondhand smoke.
But there's a burden to everyone else of paying for the diabetes care, heart surgeries and other medical expenses incurred by obese people, noted John Cawley, a health economist at Cornell University.
“If I'm obese, the health care costs are not totally borne by me. They're borne by other people in my health insurance plan and — when I'm older — by Medicare,” Cawley said.
Higher health care premiums for smokers are allowed under a health care law being put into effect, but there is no such provision for the obese.