Sin taxes could help boost 
accountability in health care

By Michael Pramenko

Accountability: taking or being assigned responsibility for something you have done or something you are supposed to do. 

With health reform in full swing, a new emphasis on accountability by our health care providers and health care institutions is taking shape.

Comparative pricing, new regulations and payment models that incentivize value over volume will enhance true accountability in the health care industry. Well, it’s about time.

However, we must look closer at the true etiology of our high health care costs. Indeed, the excessive eating, drinking and smoking in our society truly shoulder much of the blame. And, like it or not, your health insurance premium reflects the collective habits of our whole society. Make no mistake, you are being “taxed” for the actions of others.

Lasting health care reform will incentivize a culture of accountability. Real success will include personal responsibility. Simply stated, we can’t solve this nation’s health care finance problems without a reasonable response to the unhealthy lifestyle choices of the American public.

Interestingly enough, one could argue that Colorado took a step backward in this arena by legalizing marijuana. As with any recreational drug, marijuana will be abused. Its abuse will cause accidents. Its abuse will cause health problems. And, whether you use the drug or not, the increased presence of marijuana in our society will cost you money via increased medical and behavioral health care costs.

For proof, no pun intended, look no further than our ongoing societal experiment with alcohol. Its cost to society ranges in the billions of dollars per year. Alcohol’s human toll simply can’t be calculated. So, why should individuals who choose not to consume alcohol pay for the problems that alcohol causes?

Spend one evening in the emergency room or a rehab center and you’ll wisely ask the same question. Again, your health care premium includes these costs, whether you drink or not.

The answer to this lack of accountability, of course, is a sin tax that directly funds the problems that a certain product or habit creates. This money would not go to the general fund. You could call it a “user fee.” More importantly, you could also call it a “non-user’s refund.”

So, as our state goes about calculating the appropriate tax on our new state constitutional right to purchase and then inhale a mind-altering drug, we should ask for a bit of accountability. Hopefully, the tax creates a specific fund to directly offset marijuana’s cost to society and your health insurance premium. Unfortunately, because we tend to value our rights more than our responsibilities, this provision was not part of the legalizing marijuana vote last fall.

In fact, while we’re at it, let’s debate the benefits of “user fees” and “non-user refunds” on other items such as alcohol and junk food.

“Nanny state,” you say. Not hardly. “Accountability state” would be a much more accurate description. 

For further evidence, examine the obesity epidemic. This disease continues to increase our collective health care costs by hundreds of billions of dollars per year and further strains Medicare and Medicaid. Why not ask for more personal responsibility? Why not tax certain higher caloric foods and beverages and directly refund to the taxpayer by subsidizing the purchase of valley-grown fruits and vegetables with those same tax dollars?

With rights come responsibilities. It is impossible to have one without the other. As a free society, we should allow the right to eat, drink and smoke what we want and in quantities we so desire. At the same time, we should stop asking our health-conscious neighbors to pay for the bad habits of others. More specifically, we should reward and incentivize healthy living. 

Now that is real accountability. That is real personal responsibility. That is real reform.

Michael J. Pramenko, M.D. is the executive director of Primary Care Partners. He serves on the Club 20 Health Care Reform Committee and is a past president of the Colorado Medical Society.


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