As nation grapples with soaring health costs, do penalties for smokers and the obese make sense?

Here is the problem – part 1.

We all know that smokers have significantly greater health care expenditures than non-smokers.

So let’s return to the original question: Why provoke a backlash? If 1 in 5 U.S. adults smoke, and 1 in 3 are obese, why not just get off their backs and let them go on with their (probably shortened) lives?

Because it’s not just about them, say some health economists, bioethicists and public health researchers.

“Your freedom is likely to be someone else’s harm,” said Daniel Callahan, senior research scholar at a bioethics think-tank, the Hastings Center.

Smoking has the most obvious impact. Studies have increasingly shown harm to nonsmokers who are unlucky enough to work or live around heavy smokers. And several studies have shown heart attacks and asthma attack rates fell in counties or cities that adopted big smoking bans.

As a libertarian, I understand that smokers have freedom.  But since I pay for health insurance, their smoking raises my rates.

That’s the rationale for a provision in the Affordable Care Act — “Obamacare” to its detractors — that starting next year allows health insurers to charge smokers buying individual policies up to 50 percent higher premiums. A 60-year-old could wind up paying nearly $5,100 on top of premiums.

The new law doesn’t allow insurers to charge more for people who are overweight, however.

Part 2 – obesity

This one is more complex than smoking.  We can test patients for smoking regularly, and so can insurance companies.  Money does change smoking behavior.

Those who complain that they have a right to smoke and not pay higher insurance are in a word selfish.  I do not want to pay their extra medical expenses.  How do we resolve the conflict.

One could make the same argument for obesity.  Here is the problem, how do we define obesity?  Smoking is easy.  You either smoke or you do not.  But what is obesity?  How we do find a cut-point for obesity?

So let us address the smoking issue now and continue to struggle with the obesity issue.