Stupidity is in the eye of the beholder. Smoking is “stupid,” some would say, because it is unequivocally bad for one’s health. But what if the pleasure gained from smoking outweighs the decrease in life expectancy? Is that still stupid?
The United States of America has a general paradigm for dealing with these questions. Americans are free to make decisions that could be seen as stupid so long as they aren’t violating someone else’s freedom. Sure, there are plenty of instances where freedom is disallowed, gambling and drugs come to mind, but for the most part, the paradigm holds.
However, when it comes to our nation’s health, that freedom has been changing. Prompted by realizations that our country is outspending, but not outperforming, the world in healthcare, politicians have been incentivized to find an answer.
When the majority of healthcare spending is going to preventable diseases, and those diseases could be significantly reduced through improved exercise, diet and decreased tobacco use, the answer seems so attainable.
Taxes, education and other nudges away from tobacco have been in place for decades. Perhaps emboldened because of the apparent success of many of these measures, smoking has been cut in half since 1964, attention has been turning toward diet. Famously, New York City passed a law in 2013 limiting the size of sugar-sweetened drinks.
This law has been struck down, but the idea of saving people from themselves has not disappeared. Thus the American paradox: America wants you to have freedom, but if you use it in a way that seems so clearly to make your own life worse, wouldn’t it be better if someone else (i.e., the government) helped you use your freedom? This, of course, isn’t really freedom, even if the manufactured outcome is an improvement for everyone, but it is tempting for some nonetheless.
It will, and should, remain controversial to try and limit how adults utilize freedom. But what about adults who are on government assistance? Nearly 50 million Americans participate in the Supplemental Nutritional Assistance Program (SNAP), more commonly known as food stamps, which provides money for food to low and no-income individuals and families. Stanford University released a study this week that estimated the effect of banning the purchase of sugary drinks with SNAP dollars. Obesity rates among SNAP users would drop by 2.4% over 10 years, which could prevent 240,000 adults from developing type 2 diabetes.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
The study also found that if SNAP participants were reimbursed 30 cents for each dollar spent on fruits and vegetables, twice as many of them would eat the recommended amount of fruits and vegetables. There would be no projected affect on obesity or diabetes.
By forcing people to make healthier choices now, healthcare spending, including money from government programs like Medicaid and Medicare, would presumably drop. This logic was one of the reasons behind the Healthy, Hungry-Free Act of 2010. Championed by First Lady Michelle Obama, the law’s goal is to use $4.5 billion to make public school lunches healthier. The USDA says that 90% of schools are currently meeting the standards.
While there are still arguments about those standards and costs, there aren’t the same vociferous cries for freedom that accompanied New York City’s soda ban. Maybe that’s because we are closer to solving the paradox in certain situations – if the government is going to be spending money anyway on a program like SNAP or school lunches, it would be stupid not to lead people to healthier choices.
