Healthier Lifestyle, Lower Taxes

[Guest CaesarCornelius]

What do you guys think about the topic of this article?

 

Healthier LifeStyles

 

Taxing people who have had 'responsability' in their illness. That can include a lot of people.

 

CC

[Guest shrinkage]

...the only "fair" way to do this would be to "punish" people for their "irresponsible behaviours" rather than their disease and/or use of the health care system.

 

In some instances (e.g. smokers) it is easy to say that a person "is at fault" (at least partially) for related health problems. However, what about something like alcohol use or sedentary behaviour? Who would get to decide "how much alcohol is bad" and "what is the exercise threshold below which a person is defined as a couch potato"...?

 

Also, even in the one clear case above (smoking), we would have to either take a person's word (not very reliable), or force them to undergo testing to detect nicotine, etc (and this testing would have to differentiate between unintended environmental exposure, etc).

 

In short, I AGREE COMPLETELY with "making people pay" for their own self-destructive behaviour...but ONLY if they are monitored by some omnipotent force. Last time I checked, God doesn't submit checklists of everybody's health behaviours to the government, so in practice, this system would not work.

 

To paraphrase the wise sage Homer Simpson..."In theory, COMMUNISM works...in theory" (or something like that).

[Guest cheech10]

For alcohol, in fact, mortality is lowest for those who have 1 drink per day, so would we tax those that do not drink at all?

 

Even for smoking, if the government permits the sale of tobacco products it should at least be partly responsible for smoking related illness.

 

Any such idea would be a nightmare to implement. And lets face it, we all have our vices and I certainly wouldn't want others judging my personal behaviours.

[Guest redhedmed]

I agree; it would seem a little hypocritical to activley penalize people for smoking if the government permits it. Unfortunately it's not likely that tobacco will be outlawed anytime soon. Too many people still smoke to make it a good popular-opinion move, but it might be feasible for a government to make smokers pay more towards the cost of their treatment, perhaps in the form of increased tobacco taxes so that they don't have to undergo tests or whatever. That kind of moderate/realistic change would probably hurt less at the polls.

[Guest aneliz]

People make bad choices that cost the health care system money everyday...smoking and alcohol (and other drugs) are prime examples... but what about the people that intentionally speed, don't wear seatbelts, ride a bike without a helmet, go rockclimbing without appropriate gear, etc? And then there are the non-compliant people....those that have been diagnosed with diabetes (as an example) and are consistently non-compliant with meds...and of course end up with worse problems.... then there are the people that end up with multiple (and repeated) STI's and unwanted pregnancies...they too make bad choices that cost the health care system money....

 

There are very few things that 'happen' to us that require medical care that we didn't have at least partial responsibility for creating by our own lifestyle choices....

 

While refunding premiums to 'healthy' people may seem attractice, the bottom line is that the health care system is in desperate need of resources...and taking cash out of it is not a good answer. I don't think that we could afford to give people enough of a rebate that it would realistically 'encourage' healthy lifestyles...would you be motivated for an entire year by $100? Not many would...but even giving that much back to people would be a significant loss of resources to the health care system.

[Guest lex]

Not only is it incredibly difficult to draw the line at good and bad behaviour it's virtually impossible to institutionally determine how an individual makes personal health choices. Quite often, the word choice is used to describe a situation when none actually exists.

 

Consider:

 

1) A single parent who works two jobs in order to provide a minimum level of food and shelter for his/her 3 children. Maybe a 3 minute smoke break is the only source of respite from an incredibly stressful day. Someone with greater means may be able to afford to run for an hour, go to the gym, or take yoga classes to relieve stress. It hardly seems fair to slap the single parent on the hand for his/her smoking habit.

 

2) Addictive behaviour is highly variable. We would have to punish people for not quitting alcohol/smoking knowing that their genetic makeup may very well be influencing their so-called choice.

 

3) We'd have to punish people for taking on too much stress in the workplace. Thus, becoming a doctor could, under these criteria, be considered as making a poor health choice.

 

4) We'd have to punish people for eating rich, fatty foods (McDonald's fast food or home-cooked bacon and eggs). Food intake burdens the health care system significantly more than tobacco.

 

5) Cancers don't develop in all people who smoke. This is thought to be largely mediated by genetic factors of which we know very little about.

 

6) Families with limited means are often unable to afford high quality, low fat foods and parents in these families typically have less time for daily shopping for fresh produce. Thus, they'd be more likely to intake unhealthy and frozen foods.

 

The list could go on....

 

In short, I guess it's just very difficult to determine what is and isn't choice. When you start looking at the individual experience, it's not so black and white. Also, we don't know enough about how these choices affects healthcare.

 

What I fear is that this type of incentive program would likely end up punishing those that don't have many choices to begin with.

[Guest UWOMED2005]

I say we punish all those long distance runners who cost the system with stress fractures and other sports injuries.

 

Not to mention the fact they're going to be overall more healthy than us and live longer probably means they'll cost us untold costs in Canada Pension Plans and Nursing homes when they live to 104. (lousy jerks)

 

We should also go after those who choose stressful jobs and sleep fewer hours. Anybody here know anybody going into a career which involves life or death decisions and causes sleep deprivation?

 

While we're at it, why not go after ALL people living a healthy lifestyle who might cost the system extra money for pensions and later life care. Do you know how much nursing homes cost? Pensions? And it's not like healthy people are always going to be healthy. Even if they're in tip-top-shape at 89, they're eventually going to need health care. . .

 

While we're at it, we should probably in fact REWARD people who live unhealthy lifestyles and never ever see their family doctors. . . so long as they don't call 911 when they get chest pain @ 42 years of age. There's no scenario cheaper to the system than someone who drops completely dead so that the paramedics can simply pronounce death at the scene.:rolleyes

 

Truth be told, this whole debate opens up a whole can of worms. I see the original point, but considering the multitude of scenarios that can be played out in one's life it's hard to predict what a healthy or unhealthy person might cost the system.

[Guest peachy]

The reason public health is usually called "insurance" (as in Ontario Health Insurance Plan) is because we all pay in, and the people who use the system less subsidize those who use the system more, and are willing to do that so it'll be there for them if they ever do need it. If we don't charge the people who don't use it much, then like aneliz said, it's just not going to work!

 

I agree with the myriad of reasons presented in the above posts about why it isn't really a practical idea. And especially about what constitutes "responsibility". Genetics predispose people to all sorts of things, most definitely including things that we generally consider people to be responsible for.

 

But the most obnoxious part of it, to me, is the assumption that people who are smokers or obese (for example) _want_ to be that way!

 

This is simply not going to work as an "incentive" for people to change their habits. People who are smokers are already charged for it through tremendous taxes on cigarettes. People who are obese are also charged for it through paying more for food, more for plus-sized clothing, and a whole bunch of other ways.

 

People who smoke or are obese generally already desperately want not to be, and already suffer more than enough! If changing their behaviours was something that only cost a couple hundred bucks (or a couple thousand bucks, or whatever this tax proposal says), then we wouldn't have billion-dollar industries trying to help people stop smoking or lose weight.

[Guest redhedmed]

Don’t get me wrong; I know that raising the taxes on cigarettes isn’t likely to cause many longtime smokers to quit. (It might discourage a few new ones from starting though.)

 

When taking out insurance, not everyone pays the same rates because some people have more risk than others. Premiums are higher for people who are more likely to collect. Taxing cigarettes (or alcohol, or whatever else) would have the same effect as asking users to pay higher premiums for what is clearly a higher risk.

 

We don’t have to consider every risk factor (stress fractures from running, etc.). Collecting more tax in one area doesn’t oblige policy-makers to seek out every other possible area to raise taxes there too. Can you seriously imagine a government proposing to stick doctors with extra taxes because they chose such a stressful job? No, because they’d look like idiots and the opposition would cream them in the next election. The same goes for any other ludicrous scenario you could find by slippery-slope reasoning.

 

Canada can barely afford to keep the system running as it is. Insurance firms would likely have the same problem if they charged everyone the same rate. It wouldn’t be privatizing the system to introduce the occasional sin tax, so why not take a couple baby steps toward what private insurance firms are already doing?

 

(I know I’m being somewhat facetious here but I want to see what sort of replies this’ll get.)

[Guest peachy]

Redhedmed, I agree with you - it's more than possible to base insurance costs on risk factors, based on some sort of tables of projected costs, just like car insurance is priced. But whether or not we want to do this as Canadians is very much a values issue, and in my opinion, something that should be subject to public debate and referendum. It's something I personally would be opposed to, but if the vast majority of Canadians disagreed with me, then that would seem fair. But it would be a very fundamental shift in how we look at public health insurance, imho.

 

On the other hand, that's not what this article is talking about at all, as I read it. It is talking about "encouraging healthy lifestyles" by charging more tax, and also says that "we cannot penalize individuals who through no fault of their own have health conditions". To me, that's not insurance. Insurance (to me) is impartially looking at a bunch of tables about how much people are going to cost, and then charging them accordingly, and this article seemed to be more about punishing people for unhealthy lifestyles than creating an "equitable" tax system.

[Guest UWOMED2005]

One thing I'd like to see is tax credits for gym memberships.

 

Why not?

[Guest lex]

Like Redheadmed, I was being facetious with the doctor thing. However, I there is a legitimate concern over values here. When sin taxes are created by legislators, they tend to tax those “sins” that are committed by people other than themselves. Consider the pot/alcohol debate. Consider white collar crime vs the rest. Yes, it’s a slippery slope, but one of the first mandates of jurisprudence is that for a law to be fair, it must be able to be equitably enforced. This can be extended to laws that target certain populations.

 

My comment on taxing doctors for their work habits was not meant to be taken seriously as an all-or-nothing argument against selective taxation, it was just meant 1) to illuminate the class equality that might arise and 2) to be offered tongue in cheek to a bunch of people who are aiming in that direction themselves. I realize that collecting taxes in one place does not obligate to collect everywhere – I’m just not convinced that we know enough or are compassionate enough to know where, how, and how much to collect.

 

In my opinion, Peaches has it right – health care is a value-based entity in Canada and, as a nation, we’re quite proud of that. For this reason, it’s different than car insurance or private health insurance. Because we as a country deem adequate health and equitable access to health care as one of the fundamental principles of our country, it can’t be operated under the same economic structure as other enterprises.

 

UWOMED has an interesting idea though – if it was adequately supported by epidemiological studies that gym member ships were helpful in reducing health care costs, I see no problem in providing a financial incentive to help offset a portion of the cost of that investment (or any other like it).

 

Also, I’m not quite convinced that Canadian health care is heading towards a fiery end. I concede that it has some very serious funding and growth challenges but it’s not on the brink of implosion. I think that looking elsewhere can provide some helpful reference with respect to the sustainability of our system.