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We are all getting chubby, but is it the government’s business?

British government scientists claim that Britain faces a growing crisis of obesity. And of course such predictions, which carry all the usual credibility of such things, are accompanied by calls on the powers-that-be to “do something” about it, including the likes of bans on advertising for sinful foods, funding for sports and so on.

First point: even our waistlines are expanding, is it any of the state’s business? At present, one might argue that because we have socialised medicine in the form of the National Health Service, taxpayers, both slim, chubby and positively enormous, have to pay for the consequences of bad health habits. So the neo-puritans will argue for controls on how we all live to reduce the tax cost of bad habits, which is an example of what economists might call a ‘negative externality’. Surely though, the approach that would encourage good habits and treat citizens like adults is one based on private medical insurance. If people want to cut their insurance premiums, then they will have a strong market-driven incentive to do so. In a private sector model, there may be much more encouragement from health providers to get in shape and give up the triple cheeseburgers. Of course, there will always be feckless people who do not give a damn and end up demanding some kind of handout when things go wrong, but I do not see why the liberties of the majority of us should be tossed away to deal with people who are too weak willed or plain stupid to act differently. In any event, I imagine that as in the days before the NHS came along, there will be health care available for those who cannot afford it – as James Bartholomew pointed out in his book – provided through charitable means. I actually think that a charity which supports doctors might, for example, insist that if a poor person wants to get medical care for his or her obesity-related problems, then as part of any treatment, that person has to do something about their problem.

Such an approach may, at first sight, appear to be ‘unaring’ or harsh, but I think there is no greater respect that one can give to one’s fellows than to accord them the ability to act like adults.

Goodness, all this venting has made me hungry. Anyway, as I head towards the kitchen, may I recommend this collection of articles by Reason magazine on the obesity issue.

Bon appetit!

20 comments to We are all getting chubby, but is it the government’s business?

  • HJHJ

    Couldn’t agree with you more Johnathon. Of course there is a balance to be struck, but we have moved too far away from personal responsibility.

    It was this government that pretended that by forcing us to pay much more for the NHS that it would improve our health. This is a complete fallacy – for most people, most of the time, the prime determinant of health is their own behaviour. There is little or no correlation between spending on ‘health’ (or rather medical treatment) and longevity or general health. The government should not try to tell people how to behave but neither should it, through taxes, subsidise people who ignore this truth.

    Perhaps if we didn’t have to pay so much tax to pay for the NHS, we could work shorter hours and spend the time saved preparing proper food and exercising – both of which would do far more for our health.

  • Dave

    but I don’t see why the liberties of the majority of us should be tossed away to deal with people who are too weak willed or plain stupid to act differently

    And that pretty much sums up why the Libertarian movement isn’t a particularly strong political force anywhere.

    People are stupid and they are weak willed.

    Perhaps if we didn’t have to pay so much tax to pay for the NHS

    But we don’t pay very much tax for the NHS.

    I’m in the process of moving to the US and have been looking into the household tax burden when we move. My wife will be unemployed for about 4 months while we sort out her visa status, and for that time I’ll be liable for 50% of any healthcare she needs (under the plan my company have), our tax bill, in a state with no state income tax isn’t a huge amount different to my tax bill here and I’ll be getting a lot less in return for it. Sure I can take out additional cover that covers, for example, for pre-existing conditions, but that’s going to eat into our incomes more.

    Now, having said that, I’m no particular NHS fan, but I’ll say again that this is not going to be a subject a mass Libertarian movement is going to win on in the UK, and it’s not a subject where the comparative data is all that supportive either.

    There are plenty of examples of effective working universal healthcare systems.

    One last point. A customer has just moved to the UK for a couple of years. He has private cover with his employer. So far he’s been shocked at how good the medical services here are in comparsion to where he lives and how much better the private medicine is compared to where he lived in the Pacific Northwest.

  • There are plenty of examples of effective working universal healthcare systems.

    Such as?

  • HJHJ

    ‘We don’t pay much tax for the NHS”. You don’t call about 8%-9% of our entire national income much? Each family is paying around £5k p.a. on average.

    The US is not a good comparison. Although the system is different, it is still dominated by the interests of the medical unions and regulatory bodies, just as in the UK. That’s why the UK and the US have the best paid medics in the world by a long way.

    As for tax, the fact is that taxes, across the board, are lower in the US, even if they are differently applied. Contrast 17.5% VAT here with sales taxes of ypicall 6%-9% in the US.

  • I would like to point out that America has a more private health industry than any other industrial country on earth, yet are still the fattest.

    – Josh, not fat

  • HJHJ

    Wild Pegasus, what you say is true. However, the government also spends a huge amount in the US.
    The healthcare insurance legacy is also a key factor in near bankrupting some large US companies (e.g. GM) and healthcare regulation there is designed by producer interests to be expensive.

    In any case, if people want to be obese that should be up to them, provided they accept the consequences.

  • Dave

    Such as?

    For universal systems I’d take Germany, France, Japan, Sweden, Norway and Canada over the mess in the UK and the system in the US.

    You don’t call about 8%-9% of our entire national income much?

    For a free at point of delivery Universal healthcase system? No, I think that’s bargin basement pricing. Probably one of the reasons the NHS is a bit naff.

    Re: Tax
    Sure the sales tax is lower but the property taxes aren’t, and the water charges sure aren’t – at least not, weirdly, in the Pacific North West where one would think water wasn’t an issue. (although eastern Washington is a desert of course).

    As I said, I’m working out our tax situation and the US is going to be a complete nightmare and its not going to save me all that much in tax, especially not when my wife gets a visa.

    If the exchange rate wasn’t so good, it would look even worse. It certainly did when I lived in CA in 2001 at $1.40=£1.

  • ian Grey

    I couldn’t agree more, it isn’t a good idea to be fat but it is no business of the state.

    I qualify as a Fat Bastard. I wasn’t fat until I worked as an ex-pat in a really dreary country and my weight has gracefully yo-yo’d ever since through the usual reason- slightly more calories in than out.
    I might cost the NHS a fair whack in my fifties if I develop all the horrible complications of obesity related illness. However, that way I’ll pop my clogs without being a burden on the state as a Pensioner (Assuming there is any money left by then to pay pensions, my private ones are pretty much bolloxed and I don’t really want to workin the retail sector as a silver greeter.)

    I’m pretty successful at losing weight when I work at it, but the utter tedium of dull food, boring exercise regime & a near-temperance lifestyle eventually knocks me off the rails. The trouble is that good food and wine oil the wheels of social conversation and partial participation isn’t much fun. It was the same with cancer sticks but I managed to shake them off a long, long time ago. I wish I could say the same for comfort eating…

    I have a great paperback somewhere written by a NASA physician from Apollo days. It has been my bible when I am in the good cycle of the yo-yo. It debunked the entire weight loss/fitness gain industry on first read and continues to do so despite being decades out of print. The point of the book is to get it off and keep it off by staying fit and on that basis it is an abject failure

  • cryptononcommie

    Very well put. A long-held opinion of mine is that if you want “the people”/government to be forced to pay for your health care, then you have to accept the demands that “the people”/government impose upon you in order to reduce the amount of money that “the people”/government have to pay for your stupidity. If you do not want people telling you how to live, then perhaps you shouldn’t be forcing them to pay for your mistakes (opt out of the system). Perhaps libertarians should encourage this line of thought as to solidify the inherent link between “social freedom” and “economic freedon.”

    Another instance when I believe it may make sense for the government to impose lifestyle choices upon the citizenry (prevent them from becomming fat) may be if a military engagement threatening the existance/wellbeing of the citizenry, but which could potentially be prevented by conscription, is looming upon the horizon. In such a case, the government not ensuring (by force if need be) that the citizenry is in top shape so as to guarantee victory would be equivalent to treason. Thoughts?

  • Johnathan Pearce

    People are stupid and they are weak willed.

    I personally would prefer a population of people who succumb to the temptation of over-eating to the temptation to boss people around any time, Dave.

    I don’t share your contemptuous view of most human beings, but it is not necessary to believe that all people are intelligent and tough to support liberty. What matters is whether one can show that people, even if they are thick as two planks, respond to incentives. I think there is overwhelming evidence on that score that they do.

    In my experience, most people who denigrate the mass of humanity as dumb or weak are usually authortarians and bullies of some kind.

  • Johnathan Pearce

    For universal systems I’d take Germany, France, Japan, Sweden, Norway and Canada over the mess in the UK and the system in the US.

    Most of the countries Dave mentions admit a far higher element of private insurance than is the case here in Britain. It may surprise people to know that in Sweden, for example, the country has been moving away from a totally state-run approach for some time.

    There are very few examples out there of pure private medical systems, since most governments tend to interfere with health care to some extent, either out of benevolent, or more usually, politically expedient reasons. Given the problems of Britain’s soviet model of health care, such as disease infections in hospitals, surly staff and long waiting lists, Dave’s arguments are mistaken.

  • Brian

    Quite.

    A simple answer: don’t provide any healthcare for fat bastards. Or smokers. Or motorists. Or sporting people (any idea how much sports injuries ‘cost’ the NHS?).

    Or potholers. Or climbers. Or walkers in the country. Or drinkers. Or bridge players (you could easily cut yourself on those playing cards, you know, which is why the government insists on risk assesments from bridge instructors).

    Or anyone who deviates from the party line in any way.

    The cost of the NHS will fall to a record low. We could all easily afford it.

    Why haven’t the government thought of this before?

    I suggest they atone for their abysmal error by committing suicide. That would get rid of the greatest expense of all – the valueless parasites of the public sector.

  • HJHJ

    Dave, You think that 8-9% of our national income on the NHS is ‘bargain basement”? You think that 4 hours of everybody’s working week going to pay the NHS isn’t much? Given that there is little or no evidence that it has any significant effect on the nation’s health, you astonish me.

    All the evidence is, that provided people take some reasonable care of their own health, the vast majority of any benefit from ‘healthcare’ comes from simple, long established and cheap to provide treatments. The really big improvements in health over the last century or so have come not from medics but principally from better sanitation and, to some extent, better housing. Sanitation engineers have saved more lives than all the doctors put togther, at vastly less cost. Compare your water bill with what you pay for the NHS. Even cheap treatments like immunisation only have a relatively small effect – it is a little known fact that most of the killer diseases were reduced in incidence by 95% due to better sanitation and living conditions before immunisation was introduced.

    Ask any GP and their honest answer wil be that 50% of their appointments are from the ‘worried well’ that don’t need any treatment and that 90% of all conditions they are presented with will either clear up naturally or are more under the control of the patient than of anything doctors can do.

  • HJHJ

    Dave, You think that 8-9% of our national income on the NHS is ‘bargain basement”? You think that 4 hours of everybody’s working week going to pay the NHS isn’t much? Given that there is little or no evidence that it has any significant effect on the nation’s health, you astonish me.

    All the evidence is, that provided people take some reasonable care of their own health, the vast majority of any benefit from ‘healthcare’ comes from simple, long established and cheap to provide treatments. The really big improvements in health over the last century or so have come not from medics but principally from better sanitation and, to some extent, better housing. Sanitation engineers have saved more lives than all the doctors put togther, at vastly less cost. Compare your water bill with what you pay for the NHS. Even cheap treatments like immunisation only have a relatively small effect – it is a little known fact that most of the killer diseases were reduced in incidence by 95% due to better sanitation and living conditions before immunisation was introduced.

    Ask any GP and their honest answer wil be that 50% of their appointments are from the ‘worried well’ that don’t need any treatment and that 90% of all conditions they are presented with will either clear up naturally or are more under the control of the patient than of anything doctors can do.

  • Dave:

    For universal systems I’d take Germany, France, Japan, Sweden, Norway and Canada over the mess in the UK and the system in the US.

    I happen to have heard from several close and unrelated sources that the public health system in Canada isn’t pretty at all. From others, I hear that the Japanese public health system is much worse. Are you sure you’re not simply plucking wealthy nations at random to add credibility to your not-particularly-convincing argument?

  • Does NHS pay for lipo? That would really help jump start the whole fitness project, if a bunch of fat was sucked off the body first, making it easier to move.

    I pay $12 (non-taxed) a paycheck for my world class health care…which private payers come from all over the world to get because their national health service systems are rot. Tons of Canadians. Some Brits too although there’s a lot of private pay business in the UK already.

  • jb

    A friend of mine who is an eye surgeon moved to Germany a few years ago. He says they have a strictly two-tier system. Someone comes in with cataracts and private insurance – their appointment with the specialist is scheduled the same day and surgery follows soon after. Someone comes in with cataracts without private insurance – they are put ‘on observation’ for a few months and then told it is too late to do anything about it.

    He moved there from Russia, he thought the German level of equipment was fantastic, but the level of care sickened him. As soon as he acquired qualifications recognized in other countries he moved to the US.

  • Dave

    Jonathon said:

    In my experience, most people who denigrate the mass of humanity as dumb or weak are usually authortarians and bullies of some kind.

    Funny, in my experience, people who have a rosy view of the abilities of the mass of humanity are usually stary eyed socialists with an axe to grind with people who are better at things than other people. My real experience gained first as a recruitment consultant in the “industrial sector” and later elsewhere is that people are dumb and generally weak willed. It allows the stronger to bully and take advantage of them. That’s one of the reasons I got out of recruitment as fast as I could and into a real job.

    The key issue is that most systems are not as socialist as the “good old” NHS. Most are private hyrids which work, generally speaking better than the UK or US for “most” people. It will always be easy to find statistical outliers which contradict this, but the statistics complied by many many organisations suggest that there are many systems which are better value for money than the US, and better at delivering than the UK.

    Of course, the key issue is that purely as a percentage of national income, we, in the UK, get exactly what we pay for.

  • Dave

    HJHJ:

    You think that 8-9% of our national income on the NHS is ‘bargain basement”? You think that 4 hours of everybody’s working week going to pay the NHS isn’t much?

    Compared to the 10%+ that other countries pay? Yes.

    Given that there is little or no evidence that it has any significant effect on the nation’s health, you astonish me.

    Why? For me, at least, it is a moral issue. Healthcare is, at least for me, a basic service that if a civilisation can provide it should provide. I don’t think that anybody in an advanced industrial nation should die for want of healthcare.

    That is not to say it should be free at point of delivery. We certainly do not, in the UK, pay enough for healthcare. At least compared to any comparable nation, not least the USA.

    Ask any GP and their honest answer wil be that 50% of their appointments are from the ‘worried well’ that don’t need any treatment and that 90% of all conditions they are presented with will either clear up naturally or are more under the control of the patient than of anything doctors can do.

    Gosh? Really? And that means what exactly?

    Get rid of GPs? Not unlike the US system where the sick or “worried well” present at ER for support?

    Actually, I’d rather we changed the GP system in the UK and moved towards a triage service of more nurse practicioners in GP surgeries. But the real costs don’t come from sad, lonely old people in doctor’s rooms. They come from increasingly expensive and complex surgical procedures that actually do allow you to live beyond what you normally would do.

    Less than a century ago I’d have died in my teens from a minor illness that requires a silly minor surgical procedure which takes about 20 minutes. Should I mind that everyday dozens, if not hundreds of other people have the same really smal surgical procedure paid for by my taxes?

    Personally I don’t think so. I pay £40K or so in tax a year. Some of the things it is wasted on really really get me angry. Universal healthcare isn’t one of them.

  • Johnathan Pearce

    My real experience gained first as a recruitment consultant in the “industrial sector” and later elsewhere is that people are dumb and generally weak willed.

    Which means that the State, as in the case of the obesity panic currently in the news, is justified in banning whole ranges of foods, banning advertisements for “unhealthy” foods and drinks, compelling people to take exercise, etc?

    Funny, in my experience, people who have a rosy view of the abilities of the mass of humanity are usually stary eyed socialists with an axe to grind with people who are better at things than other people.

    It may be that socialists in the past had a “starry” eyed view of ordinary people and their capacities, but that is certainly not true of today’s authortarian, puritanical left. NuLabour seems to regard most people as being no more able to run their own lives than a five-year-old, hence the relentless barrage of nanny-state legislation designed to protect us for our own good.

    The truth is, based on your own necessarily partial experience of humanity, you regard most people as idiots and weak, and presumably that explains your support for the paternalistic model of health care of the NHS.

    That is not to say it should be free at point of delivery. We certainly do not, in the UK, pay enough for healthcare.

    Whether we “pay enough” is something one cannot really nail down with certainty. On some measures, spending the entire GDP of the known universe would not be enough for some people. Resources are scarce, and in free societies, decisions about those scarce resources are not made according to some Soviet concept that x or y percent is “enough” or “not enough”. But you are right on the need for health care to be priced. By pricing it, we ration it.

    As to your contention that people have a moral “right” to healthcare, they have no such “rights”. If one has the “right” to something that has to be provided by someone else, does this mean, for example, that the state should compel people to train as doctors or nurses? Such “positive rights”, as they are sometimes called, are incompatible with the traditional rights of classical liberalism, which do not tell us that we have certain claims on the lives and resources of other people, only that we do not initiate violence against others and their property.

    The truth is, Dave, and you should accept it, is that you are what I would call a paternalist Tory: disdainful of ordinary people and their capacity to make choices and hence a believer in the idea that strong and smart people should care for the lesser orders like so many sheep. It is a belief system that might have won you applause in Disraeli’s Conservative Party or indeed in Attlee’s Britain but it is not much of a selling point around here.

    rgds