NEW YORK — Faced with the high cost of caring for smokers and overeaters, experts say society must grapple with a blunt question: Instead of trying to penalize them and change their ways, why not just let these health sinners die?
Annual health care costs are roughly $96 billion for smokers and $147 billion for the obese, the government says. These costs accompany sometimes heroic attempts to prolong lives, including surgery, chemotherapy and other measures.
But despite these rescue attempts, smokers tend to die 10 years earlier on average, and the obese die five to 12 years prematurely, according to various researchers' estimates.
And attempts to curb smoking and unhealthy eating frequently lead to backlash: Witness the current legal tussle over New York City's first-of-its-kind limits on the size of sugary beverages and the vicious fight last year in California over a ballot proposal to add a $1-per-pack cigarette tax, which was ultimately defeated.
This is my life. I should be able to do what I want, said Sebastian Lopez, a college student from Queens, speaking last September when the New York City Board of Health approved the soda size rules.
Critics also contend that tobacco- and calorie-control measures place a disproportionately heavy burden on poor people. That's because they:
• Smoke more than the rich, and have higher obesity rates.
• Have less money, so sales taxes hit them harder. One study last year found poor, nicotine-dependent smokers in New York – a state with very high cigarette taxes – spent as much as a quarter of their entire income on smokes.
• Are less likely to have a car to shop elsewhere if the corner bodega or convenience store stops stocking their vices.
Critics call these approaches unfair, and believe they have only a marginal effect. Ultimately these things are weak tea, said Dr. Scott Gottlieb, a physician and fellow at the right-of-center think tank, the American Enterprise Institute.
Gottlieb's view is debatable. There are plenty of public health researchers who can show smoking control measures have brought down smoking rates and who will argue that smoking taxes are not regressive so long as money is earmarked for programs that help poor people quit smoking.
And debate they will. There always seems to be a fight whenever this kind of public health legislation comes up. And it's a fight that can go in all sorts of directions. For example, some studies even suggest that because smokers and obese people die sooner, they might actually cost society less than healthy people who live much longer and develop chronic conditions such as Alzheimer's disease.