It Makes 7 Times More Mathematical Sense to Tax the Fat than Tax the Unvaccinated
The mathematics of collectively enforcing individual responsibility.
One of the more interesting side effects of the Covid-19 culture war has been to introduce, or reintroduce, the idea that people should have to directly pay for their bad health choices. The idea gained purchase within Pro-Vax-Covid intellectual spaces mostly as a way to disguise their drive to punish the outgroup behind a veil of concern trolling. But even though I’m personally against vax mandates, I’ve always liked the idea of paying for bad choices in general, because I’m an individualist.
Forbes held a debate on the topic. The Premier of Quebec went so far as to pass a law, or an edict, or whatever Canadians do. They scrapped the plan today, literally while I was doing research for this article, perhaps because they hope it’ll get all the truckers out of the streets, but the idea has enough purchase that we’re likely to see it again.
There’s a case that bad vaccine outcomes are not being properly counted, but let’s completely shelve that. There’s a case that a lot of drain on our medical systems right now is not only due to vaccine choice but also due to the economic and social choices we as a country and culture made in 2020, but let’s shelve that too. Let’s talk purely numbers, grant the “Tax the Unvaxxed” contingent the most favorable assumptions, run the mathematics, and then do what nobody anywhere is brave enough to do. Compare that to fat people.
The Case for Taxing the Unvaxxed
On December 22 2021, the Kaiser Foundation released an analysis to determine the total costs of hospitalizations due to lack of vaccination. Relevant numbers from their analysis:
They state that 17% of US adults over 18 remain unvaxxed
They found 690,000 of what they deemed “preventable hospitalizations” between June 2021 through November 2021. I do not know if they accounted for the reduction in efficacy of the vaccines for the Delta variant, but let’s pretend they did and move on.
They quote four different sources for estimates of what a Covid-19 hospitalization might cost, all of which land at or around $20,000, and adopt that round number as an “on average” number towards the end of their release. Let’s take that at face value as well.
They conclude “unvaccinated Covid-19 hospitalizations cost billions of dollars,” which is true, but don’t get to the punch line we want, which is how many billions and what sort of “unvaxxed tax rate” we’re talking about. Let’s finish the job for them.
690,000 preventable hospitalizations at $20,000 each is $13.8 billion. 17% unvaxxed times the US population is 56,508,640 unvaxxed, give or take. The cost to the system per unvaccinated individual is the first number divided by the second, or about $245. If we’re keeping score, this is a bit more than the approximate $20 per dose and approximate $40 per administration that the government is shouldering. But the punch line, if we presume all these numbers are true and accurate, is that a universal one-time tax on being unvaxxed of $245 per person could cover the hospital bills that Kaiser identifies.
And none of that includes the realities that Omicron is more transmissible than Delta, weaker than Delta, and better at vax evasion than Delta.
The Case for Taxing the Fat
Obesity is the biggest health problem in the United States by a massive margin. It features in the predictive markers of type 2 diabetes, cardiovascular disease, gallbladder disease, colon cancer, post-menopausal breast cancer, a gaggle of other cancers, conditions affected by inflammation, and so forth, and is also the primary driver for over half of the Covid-19 death comorbidities. Prior to the Covid-19 epidemic, quite a bit of analysis was done to determine the total net cost to the system by obesity in the United States, the latest and most robust of which was performed by John Cawley and Chad Meyerhoefer in 2012. Their analysis concluded that in 2005, the total net cost to the health care system related to obesity was $190 billion dollars.
But we have to adjust that number, because we’re fatter than we used to be.
The NCHS Data Brief on Obesity hosted by the CDC indicates that obesity rates climbed from 30.5% in 2000 to 42.4% in 2018, and were 34.3% in 2005 when the Cawley and Meyerhoefer study determined the outlay.
If we do a linear projection from 2005 to 2018, we got 8.1% fatter over 13 years, climbing an average of 0.61% in obesity rate per year. Extend that trend line to 2022 and we’d expect a 44.9% obesity rate right now, setting aside the second order effects of closing the gyms and locking people in their houses after the NCHS data set ends. If we similarly linearly project the Cawley and Meyerhoefer 2005 costs, we see a cost of $5.54 billion dollars per obesity percentage point, or a projected 2022 obesity cost of $249 billion dollars. That’s one full trillion dollars’ worth of health care costs over any four year period. And climbing.
This analysis isn’t adjusted for inflation, which would adjust the number upward. It isn’t adjusted for the rising costs of healthcare either, in part because some portion of those climbing costs are literally because of climbing obesity rates, so I didn’t want the numbers to get entangled. Controlling for these two factors would make the number bigger.
When you divide this cost across the entire US population, it’s a net annual cost of $748 worth of medical care burden due to obesity. When you just divide it over the 44.9% of obese people, however, it’s a net increase in cost of $1,666. Annually.
Comparison
If we do this “tax the unvaccinated” thing that some people want to do, but we do it to obese people, we discover that we can cover the additional burdens they put onto the medical system by charging each of them $1,666 every year. A family of two obese parents and three obese children would owe $8,332 extra in taxes annually.
Or, to sum it up, being fat puts 6.8 times more burden on the health care system, from a dollar perspective, than being unvaccinated from Covid-19. During the height of the Delta wave. Before Omicron and its mild symptom profile showed up.
Every.
Year.
And this doesn’t even include the additional Covid-19 hospitalization rate associated with obesity.
If policy makers want to tax the unvaccinated, and they want to do it in an honest fashion, they’d also do a good actuarial analysis of the costs of vaccine side effects, which are real. I highly suspect they’re still less than the costs of unvaccinated hospitalizations. They would also have to adjust for Omicron knifing through the vaccines like hot butter, but if they’re right about the symptoms being milder for the vaxxed then maybe they’re still good on this front. And when they’re all done with the honest actuarial analysis, and conclude the correct number is still somewhere around $200, I have one thing to say. Do fat people first and see how that flies.
>17% unvaxxed times the US population is 56,508,640 unvaxxed, give or take.
17% is the unvaxxed over-18 population, not the US' population, so 44.3M
As for the rest of it, great, and I do wish there was a subsidy for being healthy and beautiful or, as a proxy, being able to run a 10-minute mile and complete one pull-up, at the very least
And we need to throw McDs executives in jail, or take China's example and do something far worse
Then, we could stop deluding ourselves, accept that we affect each other in ways that go far beyond the cost-sharing of socialized medicine, and try to be less individualistic.
Contrary to libertarian fantasy, you have a responsibility towards everyone around you, which you can fulfill by being your healthiest, best self.
What seems to be missing from the analysis in this comparison is a question of how much obesity is a volunteer choice. I assume part of the idea of taxing the unvaccinated is to encourage vaccination (tax the things you want to discourage), because proponents happily pay the hospital bills of the vaccinated. The point is not to cover the total cost, just the percentage that is due to voluntary choice. We know that obesity is caused to some degree by genetics, compulsion or addiction (the counter-argument to what I'm saying here is that we already DO tax cigarettes). The second point to consider is how much of obesity is due to poverty. Healthier foods tend to be more expensive, whereas high-calorie foods (fast food, sodas, etc.) are more affordable. According to the CDC, obesity is more prevalent in lower-educated and/or lower-income women (though more prevalent towards the middle class in men). So, not apples to oranges, although it makes for a compelling discussion. Part of the impetus must be a tax on "immorality", so to what degree are overweight people morally culpable?