Unhealthy Lifestyles and Universal Health Care

I must confess that I am torn on the issue of a universal health care, or access to cheap medical care.

The main question that I have rests on the fact that many health problems are caused by lifestyle choices. Alcohol, tobacco, drug use, over eating, lack of exercise, unsafe sex, dangerous hobbies or professions (such as football player), are some of the lifestyle choices that put people in need of medical care.

My question is, why should I have to pay for somebody else’s choices?

I do not want to outlaw these options. I am very much in favor of allowing people to live the types of lives in which they find the most value . . . as long as they do not harm other people. The problem with universal health care is that they turn private lifestyle choices into choices that harm other people – by forcing others to cough up the money to cover the medical bills.

Who Pays?

With universal health care, the claim that “I am not hurting anybody else” becomes a lie whenever that person does something that puts his health at risk. If you plan on sending me the bill to pay for the consequences of those actions, then your actions affect me. They harm me – in the same way an embezzler who breaks into my bank account and siphons money harms me. I will almost certainly have other things that I will want to do with that money.

The situation is much like the one I described in an earlier post on China’s anti-satellite test. That was another instance where a right to do what one pleases crossed a moral line by violating the principle, “As long as you do not harm others.”

I compared that situation to one in which a person walks into a restaurant and orders a meal. When it comes time to pay, he uses a debit card that takes the money from somebody else’s account. We can assume that the card is random – that it just takes the money out of some random account somewhere.

Because he is not buying his own meal, it is reasonable to expect that he will eat out more often, in more expensive places, and order far more than he needs, simply because he does not suffer the cost of his overindulgences. If, instead, he were forced to pay for his meals out of his own pocket, he would spend the money more wisely.

By comparison, those with unhealthy or dangerous lifestyles are also making choices that they might not have made if they were forced to suffer all of the costs of their actions, and were not permitted to charge those costs off of somebody else’s (anybody else’s) account.

By creating this subsidy for unhealthy and dangerous choices, this policy would make the world worse than it would have otherwise been. The man who can buy whatever food he wants and charge it to some random account is quite often not going to get as much fulfillment from the meal as the person would have gotten from the money taken to pay for the meal. The victim is made worse off to a greater degree than the culprit is made better off.

One might want to argue that, in the case of universal health care, the cost of the care is irrelevant. The poor health effects alone would be enough of a disincentive to keep people from performing these types of actions to the degree that it was possible to dissuade them. If somebody does not care about their health, then they are certainly not going to care about the costs.

I deny that this is true. People always act to fulfill the more and the stronger of their desires, given their beliefs. Having each person pay their own medical expenses adds additional desire-thwarting potential to these lifestyle choices. As a result, there will be some measure of reduced demand for these options. The amount of reduction is open to question, but the fact of reduction seems quite likely.

More importantly, the fact that the agent does not care about the financial cost of his choices still does not give him the right to send me the bill. A person who wants an indoor swimming pool who is willing to pay any cost does not gain from his keen desire the right to send me the bill for its construction.

If I am going to be given the bill to pay for these types of choices, then I reserve the right to have a voice in what they choose - a right to veto the most expensive (to me) options. If the costs come out of their own bank account, then its their money and I have no say in the matter. If the costs come out of my bank account, then I have a right to a say in the matter.

A Possible Solution – Supplemental Insurance

One option for dealing with these types of cases is to require that people purchase (if they can afford it) separate insurance to handle the expenses of lifestyle choices. There will still be people who will not be able to afford this insurance. However, the choice for them is to not engage in lifestyle choices that they cannot afford. These people should not drink, smoke, overeat, or engage in risky past-times unless they can afford to cover the potential medical expenses that may come from these options.

This is not an ideal solution. It would be difficult to determine which illnesses are caused by lifestyle choices. Furthermore, we would have to suspect that many doctors would be guilty of corruption and fraud if, by classifying an illness as non-lifestyle, they can get medical care for patients who would otherwise not be able to afford it. Furthermore, we will still have to deal with those who make poor lifestyle choices without the means to pay for them. What do we do with these? Let them die in the street?

This is not a knock-down argument. If we only permitted ideal solutions then we would never permit anything. Even with these problems, it is possible that the potential benefit is greater than any other alternative (which has even greater problems). We can do nothing but go with the best option available.

A Possible Solution – Tax Risky Options

Another possible solution is to put a tax on those goods and services that tend to result in increased health risks. This includes alcohol, tobacco, candy, junk food, fast food, gasoline (because people drive too much), businesses that involve increased customer risk such as skiing, and businesses that have risky jobs (as an incentive to find safer options).

It is hard to find something to tax that is related to all forms of risky activity. For example, I cannot think of a tax that could be levied to provide a disincentive to engage in unsafe sex. Yet, the fact that it is difficult to provide an examples in all cases does not argue against using the health care tax where contributors to higher health care needs can be identified.

That tax would have two effects. One is that it will raise revenue to help pay the costs of universal health care. The other is that it will lower the demand for these lifestyle choices, resulting in a healthier population, which will lower the demand for health care services.

Nothing in this prevents somebody from buying an occasional hamburger or pizza. However, the more one buys into a risky lifestyle, the more money they pay. This is only fair. The more one buys into a risky lifestyle, the more likely it will become that the agent would have need for those medical services he has already paid for.

Of course, the rich will be able to afford more options than the poor. However, this is nothing new. Everywhere, rich people can afford to live in a way that those who are not so rich cannot afford.

Punishment

If there were ever a national debate on such a policy, I would expect those who engage in these lifestyles to complain that they are being punished for their lifestyle choices – and nobody has the right to condemn and punish the private choices of another.

These people would be missing the point. This argument would be like saying that, after you stole my credit card, that my act of calling the credit card company and canceling the card would be an act of ‘punishment’ that I had no right to inflict on you.

In this case, I hasten to remind you, you are using my credit card and drawing money on my account. I am not punishing you by denying you access to my bank account. It’s my money, and you have no right to it.

Similarly, these taxes are not punishment. They are simply ways of collecting money to pay for the medical care that one’s lifestyle choices will likely create. It is more fair than forcing others, who have kept themselves healthy, to pay for the health care costs of those who have not taken care of themselves.

Lobbying

I do not expect that these points will actually make it into practice. Those who market fast food, candy, tobacco, alcohol, and other goods and services that increase health risks will lobby against such a provision - and they have more money than I do.

Yet, their arguments will be morally bankrupt, regardless of whether they are politically successful. For decades, the political power of the Southern states were sufficient to protect the institution of slavery. After the civil war, they were able to establish and maintain a set of Jim Crowe laws and a standard of “separate but equal” that was certainly separate and nowhere near to equal. However, political power does not translate into moral virtue.

For all practical purposes, the subsidies that universal health care will provide to capitalists involved in promoting unhealthy choices is one that allows wealthy businessmen to line their pockets with hundreds of millions of dollars by doing hundreds of billions of dollars of damage to others. They destroy far more than they create, and even far more than they take. They make the world worse off and, in the process, redistribute wealth and (more importantly) well-being away from those who can least afford it and to those who least need it.

Political success does not prevent this description from being accurate.

Perhaps there is a chance, however small, that the leaders of some of these companies can grow enough conscience to say, “I would not like having other people charging meals off of my bank account without my consent; I should not be taken money out of other people’s account – particularly to subsidize an industry of making people fat and sickly.”