Human Limits

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

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Taxing Unhealthy Behaviors?

There has been a lot of discussion about things like soda taxes to reduce unhealthy behaviors and address the obesity and diabetes epidemic.   The idea is that as prices rise, sugary drink consumption will fall and this will have an impact on obesity and diabetes and ultimately reduce some of the upward pressure on health care costs.   Along these lines, Denmark implemented a “fat tax” for high fat food items a few years ago but recently reversed the tax for a number of reasons.   Importantly, the fat tax in Denmark was not around long enough to determine if it would have any impact on public health.   By contrast it is pretty clear that cigarette taxes have contributed to reductions in smoking rates.


Another idea out there is to ask people to pay differing health insurance premiums for what might be called “behavioral” risk factors that are subject to personal choice and changes in behavior.  For example, smokers would pay more for their health insurance than non-smokers.   The question is how far to take this approach.   In some insurance plans there is a move to charge people more for obesity, high cholesterol, hypertension, and diabetes (this would be in addition to higher charges for smokers).   The plan would then lower rates or offer rebates as people with “controllable” risk factors addressed their issues and got “their numbers” under control.   In other words, if they lost weight, took their blood pressure, cholesterol and/or diabetes medication etc., their costs would go down.  The plans are controversial but there is at least some evidence that they work.   In the long run this should improve the health of plan members and reduce health care spending over time.  For example Safeway reported:


“…the proportion of employees classified as obese declined by five percentage points, while the proportion who were overweight declined by one percentage point. Meanwhile, 40 percent of workers and spouses who failed the blood pressure test in 2008 passed in 2009, 30 percent of former smokers registered as tobacco-free, and 17 percent who failed the cholesterol test in 2008 passed in 2009.”


Absent in the discussion is rating people based on their physical fitness.  As an exercise advocate this makes sense to me because exercise is a powerful modifier of other health risk factors.


My take is that a large fraction (estimates are in the 60-90% range) of our health and the diseases we get have major behavioral components.   We also know that only a limited number of people follow key health guidelines and practice what might be described as personalized preventive medicine.   Should those of us who do follow the guidelines subsidize insurance premiums for those who don’t?   That having been said, I think insurance plans that reward personal responsibility are essential to improve public health and reduce health care expenditures –a potential win-win for us all.   Premiums schemes that encourage personal responsibility are probably only one part of a comprehensive plan to address lifestyle related diseases, but it seems to me the more messages we send people about the importance of personal responsibility for their own health the better.


4 Responses to “Taxing Unhealthy Behaviors?”

  1. November 27th, 2012 at 8:53 am

    Ben says:

    I fully agree that insurance companies rewarding healthy behaviors are a key component to improving our nation’s health.

    However, I am not sold on the sugary drink tax that was recently passed. In theory, it is great, but what about the frequent exerciser that enjoys a Dr. Pepper or two during the day? Chances are they are paying a decent fee monthly for their gym membership, or a good chunk of change for their equipment if they are an endurance athlete, and then they have to pay more for something because other people aren’t taking care of their bodies? Now, I’m not sure what the “right” answer is, or if there even is one.

    Taxing cigarettes I have no problem with because they cause cancer, not “may lead to”, but cause. Sugary drinks are still in the “may lead to” as far as obesity.

  2. November 27th, 2012 at 2:53 pm

    Michael Joyner, M.D. says:

    Ben, I am a low grade Dr. Ppper addict so I understand, the post on Thursday will go into this in more detail. The other solution here would be to give fitter people a break on health insurance and I will do a post on this in the near future. Mike Joyner

  3. November 27th, 2012 at 10:00 pm

    Sandy says:

    For a fleeting moment, I thought I had the answer by taxing size of the drink. A can would not have the same tax as the Route 44 but then I realized you can but a case “of cans”…or multiple cans and ingest the same amount.

    I’ll be interested in seeing the future posts on this topic. I was just discussing this with a colleague. Sandy

  4. November 30th, 2012 at 2:08 am

    Sarah says:

    I’m not sold on the idea of letting insurance companies raise rates because of higher risk factors. The poorer you are in the US the more likely you are to be obese. The factors for this range from long commutes from poor communities to workplaces, to the cost of preprepared junk foods.

    Lifestyle taxes are similar. I can afford a gym membership and the time to use it now, but I have one next to my workplace and short commute. It was much more difficult when I had to find time for it in addition to a 3 hour daily commute, and impossible with a 3 hour commute and barely making enough to live.

    I actually have no problem with a sugary drink or candy bar etc tax. Then you have the problem of access to fresh foods in certain low-income urban areas. I just don’t think this is as simple as the cigarette tax. No one needs cigarettes to live, everyone requires food.

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