Human Limits

Exploring performance and health with Michael J. Joyner, M.D.

Photo of Michael J. Joyner, M.D.

Sin Tax Update

One topic I’ve posted on several times relates to the use of taxes, insurance premiums and other “nanny state” approaches to shape behavioral health.  The basic idea is most of what ails a given population is driven by behavior and that focusing on individual choice or medical care after people are sick only gets you so far.  Thus public policies that encourage better choices related to things like diet/obesity, smoking, drinking and physical activity are essential.   In other words, make healthy choices more attractive, easier, and less costly in comparison to unhealthy choices.   Here is an update on a few things related to this general topic.


Mayor Bloomberg

Mayor Bloomberg’s third term as mayor is coming to a close and the New York Times is running a series of articles reviewing his legacy.   He has been a champion of using public policy to shape behavioral health.  While Mayor Bloomberg gets mixed reviews from the citizens of New York on many topics, his efforts to reduce trans fats at restaurants, post calorie counts, reduce smoking , and promote physical activity have all gained high marks…….mostly in retrospect.


These policies were not particularly popular when they were first discussed and implemented and yapping about the so-called nanny state was and is common.   However these policies have become much more popular and perhaps show that Mayor Bloomberg (for all his billions) is someone who “cares”.   These findings should also give politicians and regulators the confidence that even if unpopular when implemented, such policies will likely become more popular with time.   Can you imagine the outcry many places if smoking bans were reversed?   It is interesting to note that the one unpopular policy is his effort to restrict the size of sugary drinks.   Is that because it is his latest effort, or is regulating what people eat and drink going to be more difficult than things like smoking bans?


Penn State Health Insurance Plan

Another interesting news report comes from Penn State where there appears to be significant (or at least high visibility) push back on efforts to link health-care premiums to the behavior of employees.

The opponents of the plan cite privacy and other concerns. It will be interesting to see what happens as more and more organizations and perhaps governments start to charge different rates for health insurance based on behavioral risk factors that are at least under some control or perhaps a lot of control by any individual policy holders.   There’s some evidence that these policies work to get people to change behavior, but will it be acceptable and how much political pushback will there be?


Gallup Poll Data

The chart below from the Gallup Organization tracks responses of the general public to questions about higher insurance premiums for smokers and people who are overweight.    The link also shows how opinion varies by political affiliation, smoking status, and self-reported obesity/overweight.  While there is significant support for adjusting premiums, there are plenty of people who oppose this strategy even for smoking.





It is hard for me to think that we are going to make the country much healthier without a bigger effort to change unhealthy behaviors.   Insurance premiums are going to be part of the mix and it will be interesting to see if they become widely adopted and how long it takes.   My bet is that they will become widely adopted and it might not take as long as people think.  The current smoking restrictions and seat belt laws would have seemed inconceivable 20-30 years ago.


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