Obesity, Health Care Costs, and Life on the Commons

Andrew Sullivan suggests, in response to yesterday’s CDC report on obesity, that if one wants to be fat, that’s a personal choice:

What’s to be done on a collective basis? I have an idea: nothing. If people want to eat themselves into misery and early death, it really isn’t anyone else’s business.

Well, perhaps. Or perhaps in the sort of commons we’ve built for ourselves, where we all share one another’s health care costs, either through pooled insurance or tax-funded care, one’s obligations spread a bit farther than the end of one’s fork.


  1. Yours is a perfect argument against universal health care. Once the government has socialized the cost of everyones’ bad health decisions, there will be enormous pressure to regulate diet, risky behavior (athletics, sex, smoking, drinking), and exercise.

    At least in a private health care market, insurance companies can charge differential rates based on risk, and individuals can choose to pay out-of-pocket if their lifestyles are deemed too risky.

    You cannot simultaneously have freedom and a free-ride.

  2. By the way, Steven, you don’t have a very nuanced view of universal healthcare. Does universal preventative healthcare differ from universally free cosmetic surgery? Must a system that provides the one, provide the other? Even assuming that all medical procedures are completely free, how many people would purposefully attempt to harm themselves because the medical costs are free? Smoking, obesity, etc. are not things people do or avoid because of rational calculation of the medical bills versus utility.

  3. EdgeWise: I don’t see how your response relates to my comment. You might be arguing that eliminating cost feedback will not result in a significant increase in unhealthy behaviors. My argument is that socializing the cost of unhealthy behaviors will lead to increased infringement on personal liberties, whether the incidence of the behaviors increase or not (although I predict that, all other things being equal, they would increase).

    In the US at least, we are already seeing it with the tobacco lawsuit settlement and the increasing number of lawsuits against fast-food providers. For the moment the tactic has been to attack the producers of unhealthy consumables (especially since this is a more lucrative strategy for lawyers), but this is merely an indirect attempt at regulating personal behavior, and we can expect the attempts at regulation to ultimately extend to individuals.

    If you are an obese, needle-sharing, heroin-addicted smoker, and I am being taxed to pay for your healthcare, why shouldn’t I expect the government to force you into some program?

  4. For better or worse, we have already a system where the cost of everyone’s bad health decisions is spread out among us all. Given that, I was merely ruminating on what our own personal ethical obligations might be to our fellows on the commons.

  5. Exactly John.

    But I wonder what would happen if Sullivan’s comments were altered slightly:

    >If people want to eat themselves into misery and early death, it really isn’t anyone else’s business.< Yup. Absolutely. I fully agree, as long as _I_ don't have to pay for it. So much for libertarian personal responsibility. I feel that if people want to eat themselves into misery and early death, they can pay their own insurance. Because I sure as ding-dang am fit and healthy and shouldn't have to pay the same rate as someone who doesn't exercise and watch what they eat. Why should I be penalized for ensuring that my decisions don't affect others? Boy, I'm feisty today. Sorry. D

  6. John: I don’t believe that we have any unchosen obligations, other than to respect the rights of others that we claim for ourselves.

    Since I didn’t choose the system we currently have, all I can do is speak out against it. You equate health care with a commons but it does not have to be so.

  7. Steven –

    Right, I don’t think we’re terribly far apart here. I’ve chosen to, for example, be a participant in my employer’s health plan, which means I’m voluntarily a part of that commons, so it makes sense, I think, for me to consider what my ethical obligations might be under that arrangement. I’m not saying that necessarily implies any such obligation, but I do recognize that I’ve voluntarily joined that commons and that the question of my moral obligation under the arrangement is worth pondering.

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