On October 15th I was on my own with my fears. Barb had flown east to North Carolina because her mom’s health was declining. My mom had urged me to relax at home rather than drive out to her place for the day. She was still having trouble believing that I was recovering so well from my hysterectomy. I had spent several days alone in my home and needed to get out and about.
I went to the local Produce Mart and walked its aisles a couple of times. Walking was not difficult. I could stand up straight. I had the cart for balance, but did not require it to stabilize me. There were people all around me in case I had difficulties, but I had no problems. I bought fresh vegetables and a package of eggs. I had picked up a couple of books on cancer and was going to try eating more cauliflower because it has been associated with cancer survivorship. You can find a plan for just about anything if you look for it. I had picked up several self-help books for people with cancer, people with a mission, and people wanting to use social media to convey their mission to others. It was easier to start with the cauliflower. You picked out a head of it. You broke into bite-sized pieces. You steamed it. You ate it. Voila!
What was my mission? I wanted people to understand that I was not crushed by a medical condition that was common and treatable. I read a number of online materials about uterine cancer, sometimes called endometrial cancer. I understood that it strikes women with weight problems and that I could have done a number of things to try to avoid it. I had not done all of those things well. No one had written that people in my situation were responsible for their own ills, but I have spent the last couple of years working on a law journal article about taxes on junk food. There are articles that make the link. They express the view that overweight people are bad citizens because they choose to overeat and impose the costs of their treatment on a society that is tired of helping them with government health care programs and higher insurance premiums.
The exercise of free will by smoking has proven stigmatizing for many people. We passed many sales and excise tax proposals because smokers were perceived as burdens on our governmental resources. These taxes were enacted to produce revenue that would fund health care programs for the care of smokers. After the taxes’ enactment, these taxes were raised for other purposes. When the government needs revenues it is easier to tax behaviors we as a society have deemed antisocial–like smoking–than to tax the generation of income. There is rarely a dollar-for-dollar application of taxes on cigarettes for programs to aid smokers.
Moreover, legislatures have found other tools to mitigate costs of caring for smokers. Some tort reforms call for the states to share in the recoveries from litigation by smokers against cigarette companies. States have directly sued cigarette manufacturers and have received settlements. Of course, some of the tobacco crops in this country were grown thanks to federal crop incentives. There is no socially responsible measurement of Gross National Product in this country. A sale is a sale. We may support the grower, criticize the manufacturer, and tax the consumer. We view these targeted exactions as fair because smokers should know better.
Has society decided to treat the overweight citizen as it treats a smoker? The media reports on national obesity as an epidemic. Every week I see a news clip of faceless torsos with bulging waistlines or cellulite-covered behinds. There is, however, no safety in numbers. The nutritionally pure will convince even the overweight people that their size is a disgrace. Smoking used to be a glamorous activity. Tobacco companies sponsored sporting events. Now we see warnings and pictures of blackened lungs on packaging and in public service ads. Smokers are acknowledged to be addicted to their cigarettes. Cigarette manufacturers are accused of manipulating their products to capitalize on their addictive properties. Does this translate to restrictions on the production of the product? Not really.
This nation’s experience with Prohibition has made that route undesirable. Proposals to decriminalize the use of some illegal drugs are acknowledgements of the futility of banning certain behaviors. Once we issue tickets for the activity we will have a whole new source of funding for public services. Already there are states that have legalized certain uses of marijuana. Not surprisingly, we now must determine how to limit access to the drug. Consumption will continue as long as the habit is ingrained through addiction, predisposition, or desire.
Alcohol is regarded as a social vice. We support the growth of many of its ingredients with subsidies. We criticize some of its producers. We tax it like we do cigarettes to discourage its consumption or to pay for its burdens on the public. We issue tickets for certain misuses of it. We jail people whose use of it leads to accidents involving vehicles. But we do not seem resolved to wipe it out like we “seem” committed to wipe out cigarette smoking.
How will we handle obesity? If we tax the junk food and the sodas, how will we handle the fact that one man’s vice is another man’s virtue? We already provide crop support programs for crops associated with the production of junk food. Will we tax creme brulee in a fine dining restaurant when we tax a candy bar at the drug store? How will we define junk food if juices contain as much sugar as do some sodas? Is a candy made almost entirely of sugar worse than one that contains refined flour or nuts? Would it make a difference if we required candy manufacturers to use whole grains in their cookies? What about so-called diet foods? Studies show that artificial sugars can stimulate insulin and adversely affect diabetics. Consumption of diet sodas can encourage some to overeat other foods. Some causes of obesity are healthy foods not eaten in moderation. What if the obese people stay fat on a healthy diet? We could make them exercise. Will we allow, and even encourage, private employers to impose penalties on overweight people through medical insurance premiums or hiring decisions? That is already permissible. We can point to the fact that fat people increase the medical insurance costs of everyone else in the risk pool. Once we make them the focus of other people’s resentment, it will be easier to convert others to the cause.
There are many models for “treating” socially undesirable behavior. The lines between products and behaviors that are acceptable and unacceptable are becoming blurry. New studies point to new causes of disease every day. BPA in soup cans’ linings turns up in the consumers’ blood and may be associated with disease. Apple juices sampled this week contained some measurable level of the metal arsenic. Are consumers of soup and apple juice bad?
As I waited in line to buy my cauliflower, I stared at my carton of eggs and recalled a time when the egg was villified for its effects on cholesterol. I eat eggs and my cholesterol count after eating was last measured at 104. A score of 100 or lower after fasting is optimal. Can I take credit for this accomplishment or will someone attribute it to good genes and still assign blame to me for my current health condition?
The problem with legislating behaviors is that it is a form of tyranny. A free society that dictates all kind of private behavior is not free. If we look hard enough at private behavior it always becomes a public burden. Should we tax consumers while we provide crop support to farmers? Should we require everyone in an automobile to wear a seatbelt while we argue about whether people who drive while intoxicated should have to install breathalyzers in their cars? Will we tax cheap junk food and not the lavish desserts served in fine dining restaurants? Will we someday make fat people eat twenty feet from the doors of office buildings so that we won’t be tempted to join them in their consumption of burgers and fries?
I got back in my car and drove to the cemetery where my dad and two of my grandparents are buried. It was windy. Leaves fluttered down from a nearby tree and scattered across the ground. I kicked goose poop off of the headstones. I thanked all of my deceased family members for their prayers on my behalf during my hospitalization. I pondered the place where my grandfather is buried. Some day I plan to join him there. I’m thinking of being cremated so he won’t need to have his own grave lowered. My ashes can be interred in the six feet of ground that covers him.
The truth is that all of us will die of something. Some of us will die before we ever become a burden on society. Some of us will pay enough in taxes to pay our own way through life and into death. Some of us will live without vice but will be a “burden” to society because of our use of crop subsidies, public schools that educate our larger than “normal” families, publicly funded hospitals, and other governmental services.
It is reasonable to tie some taxes to the negative effects of certain activities. It is also reasonable for society to recognize that interdependence means shared responsibility. I pay taxes to educate the children of others even though I am childless. They may have to pay some taxes to help me address my cancer even if I am not blameless in contracting it. I will drive at night even though I know that some others will drive while under the influence of alcohol. I will walk the gauntlet of smokers to enter a public building even though their smoke can affect my health. I am grateful for the right to live something approximating a free life. I will continue to extend to others the tolerance I wish they would extend to me. I will try not to be a hypocrite. My behaviors have consequences that affect others. I will try not to take others with me when my behaviors are self-destructive. I will be grateful when others extend me the same courtesy.
I started the day pondering my cancer, mission, and use of social media to advance that mission. I ended it with a plate of steamed cauliflower and broccoli, a microwaved egg, some brown rice, and a splash of low sodium soy sauce. It turned out to be a pretty good day. Thanks for listening.