"As the government assumes a larger share of health care costs, it is increasingly able to use that as a justification to intrude into personal decisions or private enterprises, whether it's a matter of smoking policy, trans-fats, or salt," we wrote last month. Now the Wall Street Journal is out with an editorial praising Michelle Obama's campaign against childhood obesity, reasoning, "the reality is that U.S. obesity imposes huge costs on taxpayers. In 2006, the per capita increase in spending attributable to obesity was 36% for Medicare and 47% for Medicaid, according to a paper last year in Health Affairs. Many fat kids grow up to be fat adults, and you've got to start somewhere."
This is treacherous turf. That Health Affairs paper suggests the government should consider paying for bariatric surgery, and it acknowledges it is based on a small sample: in the data set the paper is based on, "in 2006 only 329 (unweighted) Medicaid enrollees had an inpatient visit." The 47% number in the Heath Affairs article carries a footnote warning, as I read it, at least, that the margin of error is 15.4 percentage points, and that "relative standard error is greater than 0.3, indicating that the estimate is unstable." None of those limitations of the data are reflected in the Journal editorial.
But suppose one grants the point that obesity increases government health care spending. The Journal's argument doesn't take into account the savings the government might realize from not having to pay out Social Security benefits to obese Americans who die earlier. The same arguments have been made about cigarette smoking, with the argument that smoking actually nets out to saving the federal budget money. That argument points out the silliness of looking at an issue such as obesity strictly from the point of view of the federal fisc. After all, there are lots of behaviors that might cost the government health care money -- allowing disabled children to be born, allowing people to downhill ski or ride motorcycles or drive at night in the rain on cliffside roads -- that the government nevertheless allows. In most cases, allowing individuals the freedom to choose behaviors that will allow them to enjoy their lives to the fullest outweighs the government's interest in saving money. If it turns out that obesity, like smoking, nets out to a gain for the federal budget, we somehow doubt the Wall Street Journal and Michelle Obama will start a campaign urging Americans to Super Size it.
None of this is to say that Mrs. Obama isn't correct to try to make sure that the government-subsidized lunches and breakfasts served at government-run public schools are consistent with what modern medicine considers an appropriate diet. But how fat we are depends not only on what we eat but on what genes we were born with, and how we, as individuals, value the enjoyment of that ice cream sundae against the risk of a future heart attack. Government medical spending is a dangerous club to wield as a means of shaping individual behavior, because it's a slippery slope from school lunches to the ice cream section in the freezer aisle of your local supermarket. What the campaign against childhood obesity is really about is not saving the government money on health care, but sending a message about what kind and quality of life Mrs. Obama and the Wall Street Journal editorialists want Americans to lead. That may be an appropriate message -- I recall seeing Arnold Schwarzenegger doing the job as chairman of the President's Council on Physical Fitness back in the administration of George H.W. Bush. But at bottom it's really not about saving the government money, it's about imparting (or imposing, depending on how you see it) the government's idea of the good life.