Commentary

Before Feds Invade Your Kitchen, Anti-Fat Funding Should Be Voted On

This article originally appeared in the Los Angeles Times on July 30, 2004.
Federal officials have announced that Medicare is open to treating obesity as an illness. The decision means that many Americans — perhaps as many as 25 million — could soon petition the federal government for taxpayer-funded diet plans, nutritional programs, stomachstapling surgery and even health club memberships.

The price tag for this new coverage could easily climb into the billions of dollars. Yet, Congress didn’t vote on the issue. Congress didn’t even debate the issue.

It should do both.

If Medicaid follows Medicare’s lead, those billions would at least double. And it’s likely that the decision will have significant repercussions among private health insurers too. We could soon find ourselves with a national healthcare system in which those who stay fit are forced to subsidize those who don’t — a perverse incentive if ever there was one.

Despite all of this, Medicare’s decision to cover obesity received no significant public debate. The Department of Health and Human Services simply issued a decree. That’s probably because the public would never have supported it. According to a Time-ABC News poll, 87% of Americans said the primary responsibility for obesity lay with the obese person. In a recent Associated Press poll, three in four overweight Americans blamed themselves for their problem and 8% blamed their families.

For all intents and purposes, Medicare’s proposal amounts to a new entitlement program, one with the potential to rival the recent prescription drug benefit in size and scope (for all its flaws, at least the drug benefit was passed by Congress, and after a lengthy public debate).

It’s unfortunate that a Republican administration has determined that what’s on your dinner plate is now official government business. But the intrusion isn’t likely to stop there. Once taxpayers foot the bill for obesity treatments, the government can then make the argument — as it has this time — that we should take precautions to ensure that Americans never become obese in the first place.

It then becomes all the easier to enact taxes on fatty or sugary foods, restrictions on food advertising and on portion sizes at restaurants, and various other mandates on the fast-food, manufactured-food and grocery industries. After all, what’s the harm in state restrictions on what we can eat if doing so makes everyone healthier and saves taxpayers money in the long run?

Like most new government programs, this is being sold to us as a “we should pay a little now so we don’t need to pay a lot later” decision. And like most government programs, it will inevitably become a case of paying a little now and paying a lot later.

Diet and exercise plans have notoriously high failure rates — by many accounts, between 80% and 95%. We’ve been telling Americans for 25 years that a healthful diet and regular exercise are the keys to defeating obesity. And for 25 years, Americans have continued to put on weight.

Fundamentally, obesity is a private matter. The only way to address this problem is to allow Americans to make their own decisions about their lives, but to also make clear that they themselves — not taxpayers — will bear the consequences of those decisions.

The American taxpayer is already on the hook for a projected Medicare liability of about $60 trillion. We can’t afford to add another set of questionable benefits to a system that is teetering on the brink of financial collapse.

And if our public officials insist on adding questionable benefits, American taxpayers at least deserve a debate and a vote, so we can hold those responsible accountable when the program inevitably fails.

We should insist that Congress vote on Medicare funding for obesity treatments.

Radley Balko is a policy analyst with the Cato Institute.