Ah, a chance to disagree with my health care ally Kate. In response to Tommy Thompson's totally awesome nanny state proposals (make employees with health care exercise, double the price of junkfood in employee cafeterias, charge smokers more for insurance, etc), she writes:
What is this, a police state? You can't require employees to exercise. Charging smokers more for insurance is quite a slippery slope. What's next, charging overweight people more? These kinds of punishments are all speculative -- is charging smokers more for insurance an incentive to quit anyways?
First off, this is a nanny state. Small, but important, difference. As for smokers, whether or not they quit isn't my problem. But a behavioral choice that essentially ensures catastrophic illness and shoots up total health costs*? Yeah man, charge them more, me less. And you can't require employees to exercise, but you can lower their premiums if they do.
This idea that we shouldn't be honest about the impact of the choices people make is nuts. The general slippery slope retort -- next you'll charge me for skiing! Not lifting from my legs! Touching my daughter without gloves! -- is nonsensical. We didn't invade every country with a dictatorship, despite rationalizing the Iraq War in a manner that would've mandated it and nor did we solve Social Security's fiscal crisis despite spending months hyping its severity. As a society, we're completely capable of laying down lines in issues tinged with logical ambiguities or argumentative absurdities. Sometimes we're right, sometimes we're wrong. But the way to analyze higher premiums for smokers or employer policies compelling exercise isn't what's next, but an analysis of those, now. I judge it good, others judge it bad, but let's have the argument on its own terms.
*There's some ambiguity about the total costs of smokers because, though they get sicker than non-smokers, they also die sooner.
