Sunday, November 13, 2005

16 reasons Gareth Morgan sucks...

...and why all neo-liberal economists should be kept well away from our health system (I know it's too late).

In yesterday's Dominion Post Gareth Morgan explained how the government could use rational incentives to lower the cost of a public health service. For example, he suggested that anyone whose Body Mass Index was below a certain level should get a tax break. Here are some of the, many reasons that's a bad idea:

1. It's racist, Maori and Pacific Islanders tend to have a higher BMI.
2. Poor people also tend to have a higher BMI.
3. It's basically offering a tax cut to the rich and white.
4. Although it's 'common knowledge' that overweight people have more health problems, the scientific evidence for this knowledge is pretty thin on the ground, and even where there may be correlation that doesn't prove causation. If he doesn't pay the slightest bit of interest to the scientific evidence for his claims then we really shouldn't pay any attention to his proposals
5. He's basically arguing that there isn't enough incentive for people to live a lifestyle that lessens the risk of ill-health, because when they get sick they don't face huge medical costs - I would think not being in pain would be a good beginning incentive.
6. He implies that what we really need is a more privatised health system, but that governments are too cowardly to do it - because a privatised health system works so well in the United States.
7. He calls his approach the carrot rather than the stick, but it is still based on paying more tax if you're over a certain weight, which sounds pretty stick like to me.
8. There is no evidence that bodyfat is an independant risk factor for ill-health (independent of activity, diet, poverty etc.). If you were actually going to address so-called 'lifestyle' issues you could start by asking what would increase activity and nutritious food.
9. I don't think it's tax, although if they wanted to take the GST off food that'd be a start.
10. If the government wanted to ensure that people were more active more there are a number of things they could do: provide free exercise facilities, offer free public transport, and most importantly legislate for a shorter working week (I actually like the tone of the Push Play campaign, but it doesn't address any of the structural reasons people don't exercise, starting with the fact that exercise has become a commodity).
11. If the government wanted to ensure that people ate nutritious food then they could start by eliminating poverty - actually that'd probably be enough.
12. Having a low BMI is as strongly linked to health problems as having a high one (ie not very), should we tax those with a lower BMI as well?
13. In the last paragraph he makes his aim clear - the introduction of user pays throughout the health system. Which is fine for him, because he's a user who could pay.
14. "All adults at least are either taxpayers or benefit recipients" - you pay tax on your benefit - all beneficiaries are tax-payers.
15. He wants people to take 'responsibility' for their health, as if these are individual choices made completely separately from the social context we live in.
16. For example poverty is quite a big indicator of an increase in health problems (although whether that means higher health costs depends on whether poor people have equal access to our health system), does he really believe it is poor people's responsibility that they are poor?

Like Howard Morrison's comments about Rosita Vai, Gareth Morgan's fat tax shows that the current anti-fat hysteria is actually just another way of attacking the poor and brown.

11 comments:

  1. First up there are tons of fat whities running around in the west and they are not all poor. I don't think that that we should just be nice about anymore than we should be nice to people who smoke or drink to excess. It costs taxpayers for unnecessary doctors visits, drugs and procedures. Obesity is linked to a whole bunch of health problems that aren't poverty related..

    Furthermore exercise is not a commodity if you don't want it to be. It doesn't cost anything to go for a 30 minute walk somewhere. I'm all for a fat tax on bad foods.

    But personally I'm all for sending obese people to Asia. Nothing like being told your fat on a daily basis and the inabilty to buy clothes to give you an incentive to lose weight. I know it worked for me. I've still got another 5-10 Kilos to go, but I'm far healthier and happier now at a size 14 than I was when I was size at a size 22.

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  2. Stef could you please provide some evidence that obesity: "costs taxpayers for unnecessary doctors visits, drugs and procedures"

    That is evidence that obesity has been shown to cause (not just correlated to) the things that you list. If lifestyle changes led to a loss of weight then the study would somehow need to show that it was the weight loss, not the lifestyle changes, that made the difference.

    I'd also be interested in a definition of 'bad' foods. But my rant against Green food policy was going to wait for another day.

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  3. Anonymous1:29 pm

    Maia, point 3 is merely point 1 and 2 combined.

    'I would think not being in pain would be a good beginning incentive.'

    except that it's not an incentive until you're in pain, and then it's too late. A stronger incentive would be to know that it's gonna cost you if and when your unhealthy lifestyle goes bad.

    exercise is not a commodity.

    how is being poor linked to obesity? logically it would be the opposite, and being poor does not deny someone the ability to eat healthy, vegetables and fruit are amongst the cheapest food products out there.

    beneficiaries are not tax payers, despite the small print. tax is a percentage of what you earn contributed to the general fund, beneficiaries do not EARN anything, their money comes from exactly that general fund.

    It's amazing how you manage to twist a health based tax incentive into an attack on the poor and the brown, hows that paranoia medication?

    Tim

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  4. Hi Maia,

    there's a lot I'd disagree with there (despite the fact that I think GM is annoying) and that his idea (like most of his ideas is bad); but my quibbles will have to wait for another time.

    the main thing I'm surprised about is that you missed a pretty point against Morgan's plan: whether someone is overweight or not is not entirely a product of thier actions (the things that can freely choose to or not to do); it's also a product of genetics (something they have no choice) over. Which is why, I could live on a pizza and ice-cream diet fro months and still be a stick figure.

    So in effect Morgan would be - in part - taxing on the basis of their genes; which sounds something like eugenics to me.

    On top of that (as is common with free market economists) Morgan also ignores the impact of advertising on people's "choice". You think he'd be quite concerned about this being beheld to an ideology that "assumes" that people mark rational choices in teir best interests. Oddly enough, he doesn't care a hoot.

    funny that.

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  5. Terence, that is the other important point. We don't actually have any way to give people about how they can reliably lessen their BMI in the long-term, so it is ridiculous.

    Tim you'll have to explain why you think being in pain in the future is less likely to get people to modify their behaviour than paying money in the future.

    The link between poverty and obesity has been well researched and documented. I don't agree with everything in this article but it's a start - if you want more information google is your friend.

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  6. Anonymous7:30 pm

    Hi Maia,

    Sure, since it's been made illegal to drive without a seatbelt (with a monetary fine involved) a lot less people do it.

    The fact that they might get badly injured (ie pain) from not wearing one, was never a great concern for many 'it won't happen to me' 'she'll be right' but now that they will get FINED if caught, they grudgingly pull one on.

    If you live an unhealthy lifestyle the same pretty much applies, you don't think anything will really come of it, and if it does, well there's the health system to visit. But if you're paying fines in the short-term ie higher tax rate, chances are you will look at the issue NOW.

    It's not that I agree with Gareth Morgans idea, and it will no doubt never come about, but I think your response to it was lopsided.

    Also you must grant, that beneficiaries, sure as hell DO NOT PAY TAX.

    Tim

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  7. I hate to break it to you, but I'm not Fox News; I'm not going for 'Fair and Balanced'. I have an opinion and I argue for it.

    I was asking you to explain this "except that it's not an incentive until you're in pain, and then it's too late. A stronger incentive would be to know that it's gonna cost you if and when your unhealthy lifestyle goes bad."I don't see how an unhealthy lifestyle can go bad without causing ill-health and therefore, ususally, pain. But it's occurred to me that you may think that gaining weight is when 'your unhealthy lifestyle goes bad'.

    I won't grant that beneficiaries don't pay tax, they pay GST, they pay petrol tax, and their benefit is taxed.

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  8. Anonymous5:03 pm

    You seem to be missing the point re: benefits. The money they are spending is not THEIRS. It is money given to them from everybody elses tax.

    Money is really little more than a system of barter. You perform a service for me, I give you money, you give it to someone else who gives you something and so on. When you earn some of it from me, a portion of that goes to the 'government' who uses it for the functioning of general society. When the money you recieve is GIVEN to you from the general fund of EVERYBODY ELSE'S earnings, ie you do not perform a service for it, it was never YOURS in the first place.

    To say then you PAY TAX is an oxymoron, you can only pay tax on what you have earnt, as a beneficiary you have earnt nothing and added nothing to the general fund,

    let's repeat that 'You have added nothing to the general fund' You have received from it.


    I' can't be bothered labouring this point anymore, it's far too nice a day... and it IS fairly obvious.

    Tim

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  9. What's the definition of waste?

    A busload of Treasury economists going over a cliff with five empty seats.

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  10. You say pacific islanders tend to have a higher BMI, but isn't that only when they get overwhelmed by a european culture and eat our food? When I was in french polynesia there was all kinds of stuff in the newspaper about the epidemic of overweight and diabetes that was taking place because people out there are getting dramatically fatter, I got the impression that this is a recent thing, and the gov't is quite concerned.

    I just made a post about body image and Serenity in my blog.

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  11. I honestly don't know, and it doesn't really matter for the point I was making, which this tax would end up with brown people paying more tax. I suspect most of the reason is Maori and Pacific Island people tend to be poorer, and there are strong correlations between poverty and weight.

    I had a look at your blog and had noticed the Kaylee stuff. I think for TV shows they should cast to body-type, if the body-type is important. I love Jewel Saitie, and according to comments by Joss they could not find anyone in Hollywood who fit his idea for what Kaylee should look like. Which I find hard to believe, but I suppose it could be true.

    I'm so jealous you got to see Dar Williams live.

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