A favorite buzz phrase for reporting the country’s obesity epidemic is to refer to America’s “expanding waistline.” But obesity is not just busting inseams; it’s also breaking the bank.
According to the [Congressional Budget Office](https://www.cbo.gov/), an obese person spends, on average, 34 percent more on health care than a healthy person does. Last year, two researchers at [Emory University’s Institute for Advanced Policy Solutions](https://www.emory.edu/policysolutions/) estimated that this gorging on health services adds at least $200 billion to U.S. health spending annually. And the problem is getting worse.
One in three American adults and one in six kids are now obese. Over the past four decades, the number of obese adults has, according to age group, doubled, tripled and even quadrupled. If this trend is not reversed, 40 percent of all Americans will be obese by 2015.
In short, the United States is fat and getting fatter.
But for a nation debating major reforms of its health care system, this crisis and its costs have oddly managed to escape the scrutiny that the situation merits.
President Obama began this year’s health care discussion with a revealing promise – if “you like your health care plan, you can keep your health care plan.” In so doing, the president tried to ease Americans’ fears about reform. This approach may have been unavoidable, considering that the Clintons’ far more ambitious reform package went absolutely nowhere in 1993. (Of course, given the lunacy that has characterized much of the reaction to reform this summer, it may simply be the case that any attempt at health care reform in the United States will face irrational opposition.)
This warm-and-fuzzy marketing strategy has also meant that the president has generally refrained from telling Americans unpalatable truths, such as, “If you are obese, you are bankrupting the country.” I’m fairly confident that a White House speechwriter could express the idea more elegantly, but the point remains valid. Unsustainable health care inflation is not just a result of an inefficient system; it is also the consequence of Americans’ behavior.
embers of Congress have struggled to find new sources of revenue to pay for the reform package. But if policymakers were to consider addressing the obesity epidemic, the task before them would become far simpler.
A recent study by the [Urban Institute](https://www.urban.org/) and the University of Virginia found that a 10 percent federal excise tax on unhealthful foods would raise $522 billion over 10 years. To put this figure in perspective, consider that the cost of achieving near-universal health coverage is approximately $1 trillion over 10 years. With this single funding mechanism, Congress could pay for half of the coverage expansion.
There are, however, several objections to imposing a “fat tax,” the most frequently cited of which argues that the tax would not discourage people from eating unhealthful foods. But that’s only a problem if the main goal of the proposal is to reduce obesity. Giving poor Americans health care and forcing the obese to pay for their contribution to health care inflation is a worthy goal. If Congress can accomplish this feat by taxing something bad (rather than something generally good, like income), then the tax could be successful even if not a single obese person changed his or her ways.
Even so, policymakers should expect such a tax to encourage better eating decisions. Studies showing that the tax would not work are based upon how people respond to rising food prices in the market today. A government-imposed tax, however, would send a strong signal, educating consumers about which foods should be off limits.
Another criticism of the proposal is that it would be too difficult to implement. For example, what is the definition of “unhealthful”? Fortunately, the British government has an answer. In that country, a simple equation that balances unhealthful food qualities (saturated fat, for example) with healthful ones (fiber or protein) separates food into three categories: healthful, intermediate, and less healthful. The Urban Institute study based its estimates on slapping a 10 percent tax on the “less healthful” category.
Finally, some critics have complained that this tax would be unfair to poor communities, which consume disproportionate amounts of junk food because such products are cheaper. While this is true, the “fat tax” would be regressive only if the net effect of the plan would be to make low-income people worse off. These same people would receive heavily subsidized health insurance, a far more valuable benefit than the expense of higher taxes on some food items.
The “fat tax” is an odd specimen compared to many of the proposals circulating in Congress. It would be fair, straightforward and effective. That Congress and the administration appear to lack the appetite for it is regrettable.
Sam Harbourt is a senior in the School of Foreign Service. He can be reached at harbourtthehoya.com. The Pragmatic Progressive appears every other Monday at www.thehoya.com.
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