Of Flat Tax, Fat Tax, and 'Fat Cats'

A health care reform surtax on the rich makes great budget sense — and even more sense, over the long haul, for our actual health.

Politicians and policy makers who adore the rich don’t adore the progressive income tax. They’re always looking for alternatives. Conservative fans of fortune, over recent years, have been gravitating to the “flat tax,” the notion that everybody ought to pay income taxes at the same exact rate, an act of “fairness” that would mean an instant — and whopping — windfall for America’s most financially favored.

The more moderate of fortune's friends have, of late, been talking up the idea of a “fat tax.” Instead of taxing the rich to pay for health care reform, via a progressive surtax on high incomes, these moderates want to tax the sugary foods and drinks that make people fat.

This “fat tax,” at the moment, hasn’t yet gained much legislative momentum. But the working assumption behind the fat tax — that America’s expenditures for health care wouldn’t be so horribly out of control if people just worked harder at watching their weight — is rapidly hardening into our conventional political wisdom.

[1]In the last few weeks alone, two major studies have linked overweight and obese people to rising health care costs. Treating overweight patients, the federal Centers for Disease Control and Prevention reported [2] late in July, adds as much as $147 billion annually to national health care spending.

Another new study, from the Urban Institute and the University of Virginia, puts [3] the overall impact of obesity-related issues at closer to $200 billion a year.

Obesity, note [4] the CDC researchers, “continues to impose an economic burden on both public and private payers.” The “connection between rising rates of obesity and rising medical spending,” they add, has become “undeniable.”

But why have obesity rates been rising?

“Something big must have changed in America to cause so many people to gain so much weight so quickly,” the New Yorker magazine’s Elizabeth Kolbert noted [5] last month. “But what, exactly, is unclear — a mystery batter-dipped in an enigma.”

The mystery starts with the suddenness of America’s upsurge in obesity. The first reliable national data on overweight Americans comes from the early 1960s. Over the next 20 years, the share of Americans who registered in as overweight barely budged up at all.

But then, in the 1980s, American waistlines started expanding at a shockingly rapid pace. The nation’s adult obesity rate, according to the National Center for Health Statistics, jumped [6] from a modest 15 percent in 1980 to 23 percent in 1994 to 35 percent in 2006.

Analysts have advanced, for this skyrocketing, various explanations. Fattening fast food has become cheaper, relative to other foods. Restaurants are super-sizing. Corporate food giants have re-engineered food products to maximize their almost addictive fat, sugar, and salt.

All these factors no doubt contribute to the growing incidence of obesity. But all these factors also operate on a national, even global, scale. They don’t explain why some states in the United States have more obesity than others or why many other developed nations show much less obesity than the United States.

So what’s going on here? We have some good clues. Those obesity differences between states and nations turn out to follow a consistent pattern: The more unequal the distribution of a society’s income and wealth, researchers have shown [7], the more obesity. Inequality, in effect, seems to be making people fat.

Obesity follows what epidemiologists — the scientists who study the health of populations — call a social gradient. Levels of obesity, in developed societies, rise as income and social status fall. On each rung of the economic ladder, people tend to be more overweight than the people on the rungs above them.

Do “lower status” people simply “choose” to be unhealthy? That’s a charge you can hear all the time on talk-radio. But researchers disagree. People typically practice unhealthy behaviors not because they want to be unhealthy, but because they need relief — from social stress.

People typically respond to stress, investigators note, by increasing their intake of our society’s readily available relaxants, disinhibitors, and stimulants. They smoke. They do drugs. Or they eat more “comfort foods,” digestibles usually packed with sugar and fat.

The more chronic the stress, the more likely a reliance on one or another of these comforting props. And that stress becomes more chronic as societies become more unequal.

The great irony in all this? Commentators today still regularly refer to the super rich as “fat cats.” Generations ago, that label made some sense. Back then, only the affluent could afford to be fat. A generous girth signified, in those circumstances, high social status.

In our contemporary developed societies, by contrast, calories abound, and high social status comes to those who can afford to stay fashionably slim. We have, essentially, no “fat cats” any more.

Would our modern societies be healthier places if more people became slimmer? They certainly would. The health professionals striving so hard to educate people about the risks that excess pounds create are performing a vitally important service.

But this focus on individual obesity treatment and prevention, as the British epidemiologists Richard Wilkinson and Kate Pickett point out [8], overlooks the reasons why people engage in unhealthy behaviors in the first place.

[9]In the United States, levels of obesity and inequality both started soaring in the 1980s. If inequality continues to widen the gaps between us — and deepen the stress among us — our extra pounds don't figure to be fading away anytime soon.

And that brings us back to the progressive health care surtax on the rich that flat-taxers and fat-taxers would rather us avoid. Let’s not. If we really do want to be more healthy, we need to become more equal. Taxing the rich — to help bankroll health care reform — would move us ever so neatly in that direction.

Sam Pizzigati edits Too Much [10], the online weekly on excess and inequality.