NCPA - National Center for Policy Analysis


October 6, 2005

Doctors know that lifestyle choices are killing their patients, says family physician Benjamin Brewer. But what is missing from the cost equation in health policy is personal accountability.


  • Some 64 percent of adults are overweight or obese, and adult-onset diabetes is linked to obesity, according to the National Center for Health Statistics.
  • U.S. obesity-attributable medical expenditures reached $75 billion in 2003 with taxpayers financing about half of these costs through Medicare and Medicaid, according to Researchers at RTI International and the Centers for Disease Control.

The relatively few with Health Savings Accounts - along with their high-deductible insurance - bear more of a direct responsibility for their health expenditures and health outcomes. For nearly everyone else - including the uninsured who do not pay their own bills - a third party pays most of the cost.

Brewer says the health system needs more economic incentives to promote health habits. As politically unpalatable as such an approach may be, he recommends:

  • Making the costs of programs designed to help an individual lost weight, exercise or maintain their mental health tax deductible.
  • Or, he says, overweight people could pay higher taxes on food to subsidize their health costs down the line.
  • As for smokers, cigarette purchases should be tied to savings plans for future treatment of heart disease, stroke, cancer and emphysema; that way, he says, although smokers are killing themselves, they are prepaying their own way.

The government is about to embark on a Medicare drug program estimated to cost $720 billion over ten years. But Brewer says if his patients are any indication, it will do little to solve our country's biggest health problem - getting people to take personal and financial responsibility for their health.

Source: Benjamin Brewer, "Health Reform Must Begin With Personal Accountability," Wall Street Journal, September 27, 2005.

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