Jewish World Review August 20, 2004 / 3 Elul, 5764

Froma Harrop

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Consumer Reports

Lard have mercy! Government program pays obese to slim down | Mike Huckabee did an admirable thing. The formerly obese governor of Arkansas lost 105 pounds and began an exercise program. Now, he's started a state program that offers financial incentives to overweight state employees for losing weight. Not so admirable.

Good health should be its own reward. The idea that money — and not the desire to feel and look good — would be the motivating factor is troubling. We can cheer on people trying to battle obesity, but in the end, the spoils of victory all go to the individual.

Overweight is a health risk, to be sure. It can lead to diabetes, heart disease and other ailments. Citing that connection, Medicare recently said it would consider paying for weight-loss treatments.

But it shouldn't. Obesity is not in itself a disease. It is almost always a behavioral problem — the result of poor eating habits and not enough exercise. Riding a motorcycle also puts one at risk of serious medical problems. But no governor has suggested paying people to relinquish their Harleys.

The Arkansas program and others like it are flawed on several counts. If getting to a healthy weight is so important, why should taxpayers help only public workers and not the overweight hairdresser, plumber or other citizen? Suppose the worker loses weight, collects the dough, then starts putting the pounds on again — as dieters usually do. Does he have to give back the money? That will never happen.

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I know, I know. The argument is always made that weight programs, if they work, end up saving the taxpayers money. No so. It's true that states, Medicaid and Medicare all spend large sums on treating diseases caused or made worse by obesity. But over the long run, the American with bad health habits tends to cost taxpayers less money, not more.

May we hold a brutally honest conversation? Everyone dies of something eventually. The difference between people who take care of themselves and those who don't is that the first group dies at an older age than the second. The last few months of a person's life tend to be medically very expensive, whether they occur at 55 or 95.

So the obese smoker who keels over at age 68 saves the taxpayers money. He has probably collected Social Security and Medicare benefits for only three years. The aerobics queen whose careful health habits help extend her life to 90 will have spent at least 25 years in these programs.

(Some years ago, Harvard law professor W. Kip Viscusi calculated that smokers actually eased the taxpayer's burden — to the tune of 83 cents a cigarette pack. He reached that number on the basis of taxes smokers pay and their premature deaths.)

A person diagnosed with adult-onset diabetes before the age of 40 can expect to die eight years earlier than healthy contemporaries, according to researchers in Britain. How much would those eight years of collecting retiree benefits have cost taxpayers? And would treating diabetes be more expensive than other end-of-life care that older people require?

So in terms of pure economics, keeping people healthy does not save money over the long run. And in a world of limited medical resources, such programs pose ethical dilemmas, as well. Weight Watchers happens to offer a very fine service. But should the government be writing checks for a retiree's slim-down plan and not an uninsured worker's chemotherapy? And how can taxpayers justify spending $40,000 for weight-loss surgery that a change in health habits would make unnecessary?

Which brings us back to the case of the Arkansas governor. Huckabee is no doubt a smart man. Yet he watched both his parents suffer from Type 2 diabetes — related to overweight — and still let his 5-foot, 11-inch self balloon to 280 pounds. It's good that he saw the light and wants other state employees to do likewise. But why must the taxpayers get involved?

Public subsidies for weight-management programs clearly raise a lot of questions. A happy and healthy population is a social good, and broad programs to educate the public about weight loss might be a nice thing. But there are limits to helping people lose weight, and they are quickly reached when the government starts paying grownups to take care of themselves.

Froma Harrop is a columnist for The Providence Journal. Comment by clicking here.