Raise your hand if you don't smoke, chew tobacco, or vape. Now leave your hand up if you significantly limit your alcohol intake or don't drink at all. Let's keep going: If you avoid addictive drugs, whether prescription or illegal, keep your hand up. Finally, keep your hand up if your weight is normal or fairly close to normal for your height.

Congratulations for being so healthy and thanks for supporting the U.S. health care system.

Healthy individuals are paying a huge hidden tax and premium in health care to cover the cost of unhealthy behavior. In fact, our public and private insurance systems rely on the healthy individuals to pay for the unhealthy individuals. Where is the financial incentive to stay healthy? It's weak and ineffective. That must change.

Fortunately, there is still a significant number of Americans who keep a hand in the air when answering the above questions. But with an obesity rate approaching 40 percent in America, the percentage of Americans in good health is steadily falling.

In fact, as stated in a blog at Cost of Health Care News, "America is the most unhealthy rich country on earth." The blog accurately points out that "our resources are being overwhelmed by demand from people whose conditions are often the result of their own unhealthy behaviors."

Current efforts to lower health care premiums continue to look within the health care delivery system for savings. While this is a worthy endeavor, we must also pursue opportunities for patients and private industry to help control costs by addressing the behaviors and products that lead to the chronic disease epidemic in America.

Consider the following data from the Centers for Disease Control:

■ $9.5 billion is spent per year marketing tobacco in the U.S. The cost of tobacco and related disease is $170 billion per year in the U.S.

■ $2 billion is spent on marketing alcohol in the U.S. The cost of alcohol-related disease is $250 billion per year in the U.S.

■ $11 billion is spent on marketing food and beverages in the U.S. with 80 percent of that spent marketing unhealthy food and beverages high in sugar content. The U.S. has the highest per-capita consumption of sugar of any country on the planet. The estimated annual cost of obesity related disease in the U.S. is $190 billion.

■ Opioid medications — heavily marketed — are currently responsible for $78 billion in health care related expenditures in the U.S. The American Journal of Public Health stated, "Opioid use has been a commercial triumph and a public health tragedy."

Now consider the proposed tax increase on tobacco and vaping products here in the state of Colorado. Here is an excellent opportunity for healthy individuals to fight back against an endless stream of marketing and unhealthy human behavior. In fact, we should be open to taxes on those other products responsible for nearly $700 billion in annual health care costs. This is one fifth of our annual health care budget. How is it that these products and the companies that market these products are getting a free pass while we foot the bill?

Currently, the state reinsurance bill, designed to lower insurance premiums and sponsored by our own Rep. Janice Rich, is on life support as it searches for a funding mechanism. The previously proposed mechanism, reducing reimbursement to hospitals, appears to have hit a snag on several fronts.

Reinsurance is a good idea in need of a great funding mechanism. It needs a funding mechanism that can't be cost-shifted to healthy individuals who are already doing their part to protect the solvency of our health care system. It needs a funding mechanism that drives to the root causes of our extraordinarily high rate of chronic disease. It needs a funding mechanism that aligns with our goal of long-term sustainability in health-care delivery. It needs a funding mechanism that asks the same industries that profit from unhealthy behavior to pay their fair share.

The tobacco tax increase in Colorado could be a good start. Given the known costs to society, outpacing the cost of tobacco, alcohol and sugar-based food and beverages deserve to be considered a target as well. We should be providing the necessary political cover for our legislators on both sides of the aisle to take on the powerful corporations and business interests that have helped drive our health care costs through the roof. It's time. The alternative is to continue to finance the ever-increasing health care bill on the backs of those individuals making healthy lifestyle choices. That's not sustainable.

Michael J. Pramenko M.D. is the executive director of Primary Care Partners. He is chairman of the Board of Monument Health and is a past president of the Colorado Medical Society.

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