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On March 29, Jean-Marie Le Guen tabled a draft law, signed by 80 of his fellow members of the French parliament, designed to fight obesity. It includes, among other things, the setting up of a “high committee for obesity”, which would be the responsibility of the health minister, as well as an “obesity epidemic observatory”. He also proposes giving the fight against obesity the status of “major national concern”. This would then make it a “long term ailment” that could be covered by the national healthcare system. While the intentions of those promoting such a reform might be praiseworthy, this is not enough to make it an effective way of fighting obesity. Such new plans of social engineering are doomed to failure.
Mr. Le Guen is a doctor and is in charge of healthcare and health insurance issues for the Socialist Party. As such, he is accountable for dealing with concerns that might arise about the impact such a reform of already unsustainable health insurance expenses might have. Mr. Le Guen anticipated these objections when he said: “If we do not react very quickly, people suffering from obesity will see their life expectancy reduced by ten years and the balance of our social protection institutions will be seriously affected for all of us in the long term”. In other words, by halting the “epidemic”, the investment needed to provide better funding for costs related to obesity will stop health insurance from being bankrupted in the future.
How might rising levels of obesity lead to the fatal collapse of health insurance if we do not adopt Mr. Le Guen’s measures? Firstly, obesity would have many health consequences for which treatment is particularly costly. According to Mr. Arnaud Basdevant, a nutrition specialist at the Hotel-Dieu hospital who was recently quoted in Le Figaro, “It is well known that obesity leads to metabolic and cardiovascular illnesses: higher risks of diabetes, high blood pressure, heart deficiency and deep vein thrombosis.” He added that, “Osteoarthritis is more common and starts earlier. Recently a link was found between obesity and cancer.” Furthermore, Mr. Le Guen predicts that the rise in obesity cases will be such that this “plague” will become “the number one public health problem of the Twenty-First Century”. Expenses that the health system would have to cope with would then be unbearable.
The consequences of a growing obesity “epidemic” can thus be very harmful for the financial health of the national health insurance, as well as for the physical and moral health of people who are obese. We can follow Mr. Le Guen’s argument this far, but his proposal concerning health insurance will not lead to a cure for the illness he claims to be fighting. The French MP’s solution is essentially based on the idea that if wide healthcare coverage is provided by the health insurance industry, the increase in obesity cases will be limited. Mr. Le Guen can choose to ignore the fundamental laws of economics, but the consequences of such a conceit will not be erased from reality. Indeed, it is not by subsidizing it that we will fight obesity.
We must be aware that the terms “epidemic”, “scourge” and “sickness” which Mr. Le Guen uses to describe the situation make us lose sight of the way things really are. As Mr. Basdevant says, “Weight gain is initially caused by energy imbalance resulting from behavioural and environmental factors.” Obesity has to do with our behaviour more than it does an illness of fatty tissue. It is a consequence of choices we make. Every choice is the result of an individual’s reflection on the pros and cons of one option over another. The reimbursement of healthcare through monopolistic and compulsory health insurance alters the conditions of those options. By allowing an actor to have others support the negative financial consequences of his choice to eat more than is sensible, legislation invites him to choose this option, or to continue ever further down this path. This clearly amounts to an indirect subsidy of obesity.
We are not arguing that everyone is going to become obese from one day to the next just because health insurance is extended to cover obesity-related illness. The difference will be peripheral. It will be that little something that makes us decide whether or not to polish off another bar of chocolate. An example? In addition to increased healthcare coverage, Mr. Le Guen also proposes that transportation companies should have to provide accessible seats to the obese without charging them extra. This is an even more direct example of subsidy than the social security case. One disadvantage of eating that bar of chocolate – having to pay for the two places you take up rather than one - would then be removed by the law. This would be one reason less to hold back.
Mr. Le Guen’s solutions therefore consist of taking responsibility away from the people concerned. The consequences of doing so would be these: more widespread obesity, with an increase in related health problems and a “fatter” health insurance deficit than we would otherwise have been faced with.
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