Let’s Punish the Promiscuous for Increasing Health Care Costs

Original Article

By seizing control of health care benefits and coverage, the Obama administration set primal forces into motion that will soon have us fighting each other like a pack of hyenas battling over a small carcass. Indeed, by creating a system in which we perceive that the money our neighbors spend on medical care reduces the resources available for our own, Obamacare has sown the seeds of cultural discord and cracked the foundations of societal comity.

As in nature, resource shortages usually hurt those least able to protect themselves. Thus in the United Kingdom’s socialized National Health Service, invidious rationing is already a way of life. Indeed, repeated exposes in the U.K. media have shown that the elderly and disabled are often denied efficacious treatments in order to pay for those deemed more deserving based on “quality of life.”

But that is just the beginning. Some now want to punish the obese too. For example, Cristina Odone, the former editor of the Catholic Herald, recently mounted a decidedly un-Christian attack against “the fat” at the Telegraph, opining that they should be forced to the back of the health care line:

If a 20-stone, 30-something woman comes into hospital with a bad diabetic attack, does she deserve to be at the front of the queue or the back? She has chosen to stuff her face with Mars bars and Coke, and is now suffering the consequences of her choice. …The NHS has to consider that there are deserving cases and undeserving ones. Age should not be a barrier to optimum care; but bad habits should be.

Never mind that the causes of obesity aren’t that simple. Odone’s call to discriminate based on weight shows that centralized health care unleashes Darwinian impulses that tear at the very unity of society.

It is already happening here, even before Obamacare’s fangs fully bite. Administrators of a Massachusetts hospital announced recently that they will no longer employ smokers — even if the tobacco is indulged solely at home! In Cleveland, an obese boy was taken away from his home and put into foster care solely because he was severely overweight. Meanwhile, Mayor Rahm Emmanuel is punishing Chicago city employees who fail to join a certified wellness program by surcharging their health insurance premium $600 annually.

With centralized health care, there is no such thing anymore as “mind your own business” because anything our neighbors do that can increase health care costs becomes our business. Thus, the Los Angeles Times editorialized in favor of punishing the fat:

If an individual’s body mass index isn’t a purely personal matter, what is? We have the right to choose between healthy food or junk food, even if the latter is more likely to result in obesity and related health problems. But once our choices affect others, there’s a natural conflict between individual freedom and social responsibility. In a nation where rising healthcare costs and diminished access to medical care are issues of grave concern, personal decisions are no longer strictly private.

Okay: If that’s the kind of society we want, if we really intend to unleash the lifestyle police, then let’s also target the promiscuous. After all, under the LA Times’ logic, those who hook up for one-night stands, have multiple “friends with benefits,” attend public sex clubs, commit serial adultery, have scores of sexual partners, etc., certainly are making “choices that affect others” by potentially increasing health care costs. Indeed, one could say that their “personal decisions are no longer strictly private” — even though they are among the most intimate one can make. After all, living promiscuously increases the likelihood of contracting a sexually transmitted disease, experiencing or causing an unintended pregnancy, suffering depression and other mental health problems, and so on. In fact, when you think about it, promiscuity leads directly to deadly and very expensive diseases such as AIDS — and in a much faster timeframe than either smoking or overeating!

So, how about legally requiring warning labels and imposing special taxes on media that promote open sexual lifestyles such as Playboy and Cosmopolitan, as well as cable channels with risqué fare such as HBO? Hospitals can refuse to employ anyone with genital warts. Perhaps social workers should consider removing promiscuous teenagers from their homes and putting them into foster care. Let’s impose a surcharge on Medicaid patients who have been treated repeatedly for an STD or had multiple abortions. If we know a patient has gotten sick due to sexual irresponsibility, let’s force them to the back of the health care line!

We shouldn’t do any of that, of course. And we almost certainly wouldn’t. In a politically Darwinian society, only the metaphorical runts of the litter — e.g., the culturally incorrect like the fat and smokers — are subjected to moralistic judgments and policy punishments. In contrast, people who are openly promiscuous are among our most famous and popular cultural icons.

Then again, once the forces of lifestyle authoritarianism are unleashed, that could change. The same impetus that made the Marlborough Man verboten today can turn on Madonna tomorrow.

Wesley J. Smith is a senior fellow at the Center on Human Exceptionalism, a consultant for the Patients Rights Council, and a special consultant for the Center for Bioethics and Culture.

Wesley J. Smith

Chair and Senior Fellow, Center on Human Exceptionalism
Wesley J. Smith is Chair and Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism. Wesley is a contributor to National Review and is the author of 14 books, in recent years focusing on human dignity, liberty, and equality. Wesley has been recognized as one of America’s premier public intellectuals on bioethics by National Journal and has been honored by the Human Life Foundation as a “Great Defender of Life” for his work against suicide and euthanasia. Wesley’s most recent book is Culture of Death: The Age of “Do Harm” Medicine, a warning about the dangers to patients of the modern bioethics movement.