From an economist's perspective, there would be less reason to grouse about unhealthy behaviors by smokers, obese people, motorcycle riders who eschew helmets and other health sinners if they agreed to pay the financial price for their choices.
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.
It's tricky to play the insurance game with overweight people, because science is still sorting things out. While obesity is clearly linked with serious health problems and early death, the evidence is not as clear about people who are just overweight.
That said, public health officials shouldn't shy away from tough anti-obesity efforts, said Callahan, the bioethicist. Callahan caused a public stir this week with a paper that called for a more aggressive public health campaign that tries to shame and stigmatize overeaters the way past public health campaigns have shamed and stigmatized smokers.
National obesity rates are essentially static, and public health campaigns that gently try to educate people about the benefits of exercise and healthy eating just aren't working, Callahan argued. We need to get obese people to change their behavior. If they are angry or hurt by it, so be it, he said.
"Emotions are what really count in this world," he said.
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