In recent posts, I raised an objection to "free health care" on the grounds that it is a subsidy for unhealthy lifestyle choices.
It also objected that it is misnamed, because the health care is not free. What we are really talking about is a legal right (where no moral right exists) for people to make unhealthy lifestyle choices and to force others to pay any resulting medical costs under penalty of death. "I choose to smoke. You must pay for my lung cancer treatment under penalty of death if you should refuse. "
One move that an increasing number of companies are taking against this is to require that unfit employees pay more for health insurance. Specifically, obese people and smokers have larger payroll deductions than other employees. "If you choose these options, you pay the costs – not your co-workers."
Overall, the use of penalties is expected to climb in 2012 to almost 40 percent of large and mid-sized companies, up from 19 percent this year and only 8 percent in 2009, according to an October survey by consulting firm Towers Watson and the National Business Group on Health. The penalties include higher premiums and deductibles for individuals who failed to participate in health management activities as well as those who engaged in risky health behaviors such as smoking.
(See Reuters, Firms to charge smokers, obese more for healthcare)
This, to me, seems a reasonable way to go. It provides people with a financial incentive to make healthier choices. It also provides parents who care about their children an additional incentive to give their children healthier habits. And it provides a more immediate and comprehensible disincentive to participate in those options than vague warnings about the possibility of having medical problems in the indefinite future.
The fact is that these choices that some employees make are one of the reasons employees are paying so much for health insurance, and why some companies do not offer health insurance at all. They simply cannot afford to make this option available and stay in business.
Somebody has to pay these costs. If the smokers and the obese are not paying them, then somebody else is.
There are people objecting to this practice as being unfair to poor people who do not have the same access to fresh foods or a gym that rich people do.
There are also fears the trend will hurt the lower-paid hardest as health costs can eat up a bigger slice of their disposable income and because they may not have much access to gyms and fresh food in their neighborhoods.
I was surprised that some people would consider this a serious objection. It eats up a bigger slice of the disposable income of those who choose to smoke, overeat, and under-exercise. This is the true in the same way that higher ticket prices eat up a bigger slice of the disposable income of those who go to movies. But the option is still there not to go to movies, smoke, overeat, or under-exercise.
I see no reason to give a person who makes the choice to smoke or overeat or under-exercise the option of forcing others to pay for the consequences of their actions than to give investors who lose their money the option of forcing taxpayers to bail them out of their financial problems. Freedom means that you have the liberty to make your own choices, and to live with the consequences, good or bad.
A better response, I would argue, is not to fight for subsidies for unhealthy lifestyle choices, but to use these costs as an additional incentive to get people to make healthier choices. The purpose of these options is not to fleece the poor and to get more money from them. Instead, the hope is that they would choose options where they can avoid paying these additional costs.
Actually, my first thought when I read the objection that the poor have less access to good food and gym membership was, "Then shouldn't we be working on giving them better access?" Which option is better: to pay huge amounts of money to cover avoidable health care costs, or to use that money instead to provide people with healthier options? If we are going to subsidize lifestyle choices, let's subsidize health and fitness rather than that which is unhealthy and unfit.
That, however, was before I asked my second question, "How much does it cost to not smoke, to not overeat, and to not under-exercise anyway?"
Of course, all of this is incompatible with the idea that people are entitled to "free" (force others to pay under penalty of death) health care. It is more compatible with the idea that those who create an avoidable cost should pay the avoidable cost – or, if they don’t want to pay the costs themselves, to avoid those costs instead.