Recently, former Bush Health and Human Services Secretary Tommy Thompson and ex-Clinton HHS chief Donna Shalala gathered in Washington to take part in the latest in a series of lectures sponsored by American University and former Sen. John Breaux (D-Louisiana). The lecture series brings alleged "political opposites" together in an effort to find bipartisan solutions to America's health care crisis.
Be wary. Warm and fuzzy phrases like "bipartisan solutions" inevitably translate into "benevolent government program." Such comings-together of political foes are rarely commenced for the purpose of, say, eliminating government waste, or correcting government distortions of the free market.
A previous round of these health care lectures cast Newt Gingrich and Hillary Clinton as the featured unlikely bedfellows, and produced a legislative proposal that was billed as an attempt to "modernize medical record keeping," but would essentially create a federal database of patient records, raising some significant privacy concerns.
Shalala and Thompson also touted the database proposal, as well as Massachusetts' recent plan to require health insurance for everyone in the state. But most media accounts of the event overlooked another, also troubling item both endorsed. According to a UPI account of the lecture, both Thompson and Shalala agreed "that governments should intervene to encourage healthy habits through tax penalties on unhealthy foods."
While Shalala's support isn't all that surprising, Thompson's embrace of the so-called "fat tax" is noteworthy. While Thompson did his part in propagating obesity hype during his stint at HHS, he was at least good about emphasizing personal responsibility, and stressed that private solutions to weight gain were preferable to government intervention. When I interviewed him at an obesity summit in June 2004, he even touted the idea of "medical underwriting," freeing health insurance companies to vary the premiums of their customers according to risk, the same way auto or life insurance companies do.
Thompson's coming-around on a fat tax is significant, and shows just how successful the public health left has been at selling the obesity panic, and particularly its ability to garner mainstream acceptance of its wackier ideas. Time and again, obesity-fighting talking points that were once the stuff of parody have crept into the realm of "serious public debate" (to the detriment, I might add, of "serious public debate").
The fat tax idea is commonly "credited" to Kelly Brownell, the Harvard public health activist recently named by Time magazine as one of the 100 most influential people in America. If he's finally managed to sell this stinker to Thompson, not to mention to pundits as disparate as David Frum and Nicholas Kristof, perhaps Time is on to something about the guy's influence.
The fat tax is a bad idea for a variety of reasons.
First, there's the problem of determining what foods are "bad" and worthy of the tax, and what foods are "good" and should remain fat-tax-free. Crackers, for example, seem pretty innocuous. But what about cracker-ish snacks like Goldfish or Cheese Nips? Triscuits? Wheat Thins? At what point does the saltine become a death snack?
And what about fattening foods with health benefits? Should chocolate be taxed? It's certainly fattening, but dark chocolate is full of antioxidants, and might rightly be considered health food. The same with olive oil. What about fruit juice? According to the USDA, pure juice satisfies a serving of fruit, but one glass of most juices contains more calories than an equally sized serving of soda. Dairy products are chock-full of calories and saturated fat, but still deliver calcium.
Even with perfect information, these decisions present problems. Of course we don't have perfect information. Which raises the second problem with the fat tax: How do we know which scientists, studies, and organizations we should trust to tell us what should and shouldn't be taxed?
The scientific community has been notoriously schizophrenic about its dietary recommendations, pretty much for as long as there has been a "scientific community." Many Americans trust government agencies like NIH, the USDA, or the CDC to sift through the data and come to the right conclusions. But government agencies are beset by competing interests, public choice failings, poor incentives, and internal politics. See the long-running saga over the Food Pyramid, for example, or the controversy over the CDC's mortality figures with respect to obesity. It's one thing for these government agencies to recommend what foods we should eat, in spite of these shortcomings. It's quite another for them to begin coercing our food choices with the force of law.
Some might suggest self-labeled "public health" groups like the Center for Science and the Public Interest or the Robert Wood Johnson Foundation might be an option. But many "public health" organizations, including these two, have near-puritanical agendas that ought to call their recommendations into question, too. Both CSPI and RWJF, for example, have spent millions of dollars promoting neo-prohibitionist public policy, despite near-universal consensus among scientists over the last decade that a drink or two per day can effect enormous health benefits, more so even than changing diet or increasing exercise.[i]
A fat tax would also be regressive. Lower-income people naturally chose calorie-dense foods that offer more bang for the buck. It's true that a fat tax would make "junk" food more expensive for them. But it would do little to make "good" food like fresh produce less expensive, easier to prepare, or more accessible. Which means that under a fat tax, the people who already spend the highest percentage of their incomes on food would likely need to spend even more, with little or no corresponding change in diet.
More fundamentally, we ought to have a serious debate over whether it's appropriate to use the tax code to alter behavior. Supporters of the fat tax argue that we already use the tax code to encourage people to do a variety of things, from quitting smoking to having babies to giving to charity. They're right. But that "we do it already" doesn't mean it's wise or appropriate, and it's certainly no reason to expand the practice, particularly to behavior as private and intimate as what we chose to eat.
It's clear that the public health crowd has embraced Mahatma Gandhi's old axiom about effecting change, "First they ignore you, then they mock you, then they fight you, then you win." Once ridiculed, fat tax proponents are now taken seriously. This despite the fact that there's little evidence that our growing bellies are affecting life expectancy, or causing the predicted spikes in allegedly fat-related ailments like cancer and heart disease.
And don't think it'll end there. A bevy of yet-crazier anti-obesity proposals are now making their way into news headlines and op-ed pages. The Chicago Tribune recently compared Oreo cookies to heroin. The same paper ran a piece from a doctor imploring the Surgeon General to regulate portion sizes at restaurants. A recent Washington Post op-ed recommended the federal government allocate "calorie credits" to food producers, similar to the way "pollution credits" are distributed in the manufacturing industry. And public health officials in New York are calling for a ban on trans-fats in the city's restaurants (the ban is voluntary -- for now).
Compared to such lunacy, a "fat tax" seems downright practical. Of course, that's the point. And in a few years, when the latest round of hysterical recommendations come out from the public health crowd, the idea of health inspectors paying a surprise visit to a New York City restaurant to inspect for trans-fats and portion-sizes (the way they now inspect private offices for ashtrays) won't seem so off-the-wall, either.
The author is a policy analyst with the Cato Institute.
[i] See for example, Abigail Zuger, "The Case for Drinking (All Together Now: In Moderation!)," New York Times, December 31, 2002, p. F1, ""A drink or two a day of wine, beer, or liquor is, experts say, often the single best nonprescription way to prevent heart attacks—better than a low-fat diet or weight loss, better even than vigorous exercise...The science supporting the protective role of alcohol is indisputable; no one questions it anymore. . . . There have been hundreds of studies, all consistent."