Reward or Penalty: Which is the Stronger Tool in the Fight Against Obesity?
Safe driving makes the road better for everyone; buying homes, having children and going to school are activities that encourage economic growth. These behaviors provide relatively clear benefits, from both monetary and ethical standpoints, to society as whole. In return, safe drivers receive discounts and cash bonuses from their auto insurance companies and Americans are able to deduct expenses related to the above activities from their annual taxes. Essentially, when people participate in activities or behaviors that save money, they are being financially rewarded. These rewards provide motivation and appear to strongly encourage the continuance of such behaviors. This begs the question then, why is this same principle not applied more heavily to preventative health measures?
Despite being the world’s richest and most economically powerful nation, the Unites States ranks 28th in life expectancy and 70th in overall health, according to the Social Progress Index. Nearly 50% of the hefty $2.7 trillion price tag on health care is spent treating diseases associated with inactivity such as obesity, diabetes and heart disease. It is time to find a way to stop spending billions of dollars treating preventable disease and switch the focus to preventative health. We can do this by encouraging Americans to be more active and offering a reward incentive. According to a recent study in the American Journal of Preventative Medicine, financial incentives clearly increase exercise adherence.
Some health insurance companies are starting to pick up on this idea. Kaiser Permanente and Humana already have millions enrolled in incentive-based wellness programs. Incentivized rewards are based on collective health improvements; the more people move, the less they pay. The same blueprint can be implemented on a much broader scale by private companies and more importantly, the U.S. government. Tax credits for gym memberships and other preventative care measures would likely go a long way to encourage individuals to continue those activities, and ultimately reduce the mounting health care costs associated with disease and obesity.
The idea of incentivizing preventative care measures also has a flip side; what about tax penalties for the obese? The argument for this is simple: health care costs for the obese are not shouldered merely by those individuals but also by others in their health insurance plan and eventually, by Medicare. Should those individuals have to pay a financial price for their lifestyle choices that may lead to heart disease, diabetes and other obesity and inactivity-related diseases? Perhaps this would provide an incentive to change their behaviors and further encouragement for healthy individuals to maintain theirs.
Not surprisingly, there is a great deal of controversy over the idea of a so-called “fat tax”. The genetic component of obesity leads some to suggest that a tax penalty is not fair for some individuals who “can’t help it”. Some even argue that obese individuals will die sooner creating more front-loaded health care costs, but ultimately healthy people end up costing just as much over several more decades of life.
Something must be done to reduce the ever-increasing obesity rates and their accompanying disease and health care costs. At the end of the day the simple question stands - which is more effective; reward, punishment, or perhaps both?
Mitchell MS, Goodman JM, Alter DA, John LK, Oh PI, Pakosh MT, Faulker GE. Financial incentives for exercise adherence in adults: systematic review and meta-analysis. American Journal of Preventative Medicine, 2013; 45(5), 658-667.