Scott Atlas from the Hoover Institution had and article recently pointing out that if fat people had to pay more for insurance they would be forced to take responsibility for their personal problems. Under the provisions of ObamaCare insurance costs will be equitable and not based on personal risk factors, so fat people will pay the same insurance premiums as someone who is in shape, even though their expected health costs are dramatically higher.
His argument seems to be that we should force people to take care of themselves by charging them higher premiums. As presented the argument is not quite correct. It is not the government’s business to force people to stay in shape. I am opposed to cigarette taxes intended to curb smoking, and equally against a fat tax meant to force people to exercise. (those who support cigarette taxes should also support a fat tax.) Insurance premiums also should not be a tool for influencing behavior, which is apparently properly done with taxes, as the Supreme Court recently reminded us.
Insurance premiums should reflect expected health costs. Fat people should pay higher premiums simply because they are purchasing higher coverage. Charging them a fair price for their more expensive product is not a punishment, any more than lower premiums for healthy people would be seen as a reward. It is true that higher premiums would also have the effect of encouraging healthy lifestyles, which we should be aware of, but this should be a desirable side-effect of charging the proper price, and not the motivation.
Amanda Marcotte over at Salon (via Scott Rudd) found this suggestion extremely offensive. She declares that fatness is beyond a person’s control, so we should not punish people for being fat. (it seems that numerous experiments have shown that quitting smoking is no more effective than dieting, so I wonder if she also believes smokers should not be charged higher premiums.)
Even if her contention was correct, and fatness really is not an issue of personal responsibility, fat people should still pay higher premiums. They are still seeking a more expensive product even if it is through no fault of their own. Marcotte’s illogic reveals the socialist motives of the supporters of ObamaCare. Insurance, in her mind, is not a product people buy because they need it. Insurance is just a way of distributing the cost of healthcare, while the provision of healthcare is a social responsibility, not a service.
ObamaCare is not meant, contrary to its public selling points, to require everyone to take responsibility for their health costs, and to prevent people from being public liabilities. The equal cost provision gives the lie to that argument. ObamaCare is meant to socialize the provision and payment of healthcare. In this sense the Supreme Court was right, but insufficiently so, when they said that the penalty for not buying insurance is a tax. Not only is the penalty a tax, but also the insurance premium is a tax.
Insurance, as Marcotte and her crowd see it, is exactly the opposite of personal responsibility. Insurance, in their mind, is the means by which we disconnect the provision and payment of health care, so that people do not actually have to pay for the healthcare they need. Asking people to take responsibility for their healthcare would mean requiring the healthcare market to be as individual as possible, and fully allow the health insurance companies to charge premiums based on individual considerations. When everyone is required to buy insurance but the cost of insurance is uniform, the function of the individual mandate is to remove responsibility from others, and not to demand responsibility from the purchaser.
Marcotte’s ridiculous claim that healthy lifestyle choices are not a personal choice reflects the same attitude of deflecting responsibility. Arguing that people can freely choose to be healthier means that people are expected to take responsibility for themselves, therefore, it must be wrong. She cannot accept a world where people need to take responsibility for their health any more than she would accept people taking responsibility for their healthcare.