Monday, January 12, 2009

NY Times Misconstrues Paterson's Health Policies

In yesterday's NY Times, the paper seeks to analyze Governor Paterson's health agenda-and in the process badly misconstrues the way in which his policies will, or will not, impact the lives of New Yorkers. The Times sees this agenda as somehow promoting inner renewal, since the governor is, "...turning the familiar call for political change into an appeal for healthful living as he promotes a number of anti-obesity measures, from a sugar tax on soft drinks to posting calorie counts in chain restaurants. He has joined what has become a movement looking inward, asking people to blame themselves for their bad health."

Now, if the governor is looking to tax the folks for drinking Coke and Pepsi, this isn't a call, in our view, for any inner transformation: taxing is by its nature a coercive act. This is the government acting in ways to dictate what it believes to be healthy behavior-a trend that is decidedly unhealthy for the long term prospects of a free society.

The Times does, however, recognize the extent to which this effort may fall flat: "Lifestyle changes are easier said than done. Changing ingrained behavioral patterns, doctors say, can be as hard as getting legislators to pass an income tax increase." In fact, it's a lot easier to get a legislature to increase taxes, especially one that simultaneously is marketed as good for our health. But will the tax on soda be effective?

As one doctor from NYU told the Times: "At the N.Y.U. opening, in mid-December, Dr. Robert I. Grossman, dean of the School of Medicine, said it was “relatively easy” to define molecules or understand abnormal conditions. But, he added, “Our failure as a society has really been to appreciate the difficulty in modifying behavior.”

But the paper lauds Paterson for his attempt, while eliding both the difficulties as well as the dangers inherent in this approach to health policy: "It is hard to fault the governor for trying. When there is no money, the challenge for smart politicians is to present an agenda that does not seem to cost anything. His health agenda, much of it needing legislative approval, echoes public health campaigns pioneered by Mayor Michael R. Bloomberg in New York City and Gov. Arnold Schwarzenegger in California."

This misconstruing of the Bloomberg Nanny-style approach, of course disregards the fact that tax policy does have a cost-and, as in the case of cigarette taxes, can mean millions of dollars in lost revenue to the city and state (something Bloomberg belatedly realized). Which brings us to the soda tax.

As the Times points out: "His most aggressive proposal is to charge an 18 percent tax on sugary soft drinks (but not diet drinks), which he estimates would reduce consumption by 5 percent and raise $400 million in revenue." Where this estimate comes from is anyone's guess-and we believe that's all that it is, a guess. As one researcher remarked: "There’s a lot of buzz about prevention,” said Peter J. Neumann, director of research at the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center in Boston. “In general, I am sympathetic to that, but you have to be careful about what you’re claiming and about the science and the evidence.”

Which may mean that there will be almost no behavior modification as a result of any soda tax (except in the case of Indian retail sales, as we've pointed out)-that is, should it pass: "While there is good data that links stopping smoking to preventing lung disease, she said that as far as she knew, there was little data on the health value of a soft-drink tax or of banning junk food in schools. This is partly because the value is so hard to measure. People who are deterred from buying soda might substitute other sugary drinks. Students deprived of junk food might still nibble some of the candy they sell for school fund-raisers."

Who cares about the evidence; not when it's better to appear good than to be good-and not when your real objective isn't health, but simply revenue enhancement. Dr. Russell from Rutgers understands the nuances here: "Dr. Russell said that what struck her about the governor’s agenda was that it took health care outside of the medical sector, like food and water regulations. “You don’t go to a doctor’s office, you go to a greenmarket,” she said. “You’re not in a hospital when you get those calorie counts.” To some degree, she said, the governor’s seemingly low-cost proposals represent a subtle kind of cost-shifting, with little recognition of the impediments. It may be hard to walk in suburban neighborhoods with no sidewalks, or hard to leave work early to go to the gym or cook a healthy meal when jobs are scarce. “In fact, time is one of our ultimate scarce resources...”

What's nettlesome about the Times article is that the reporter presents some very good skeptical evidence that Paterson's going in a wrong, and possibly self-defeating, direction-yet she ignores it and draws unsupportable conclusions from the evidence: "The N.Y.U. center’s director, Dr. Olugbenga G. Ogedegbe, said his own studies showed that patients were turned off by being told that something terrible would happen if they did not take their medicine or eat right or exercise. “Positive psychology can help in the adoption of healthful behavior,” he said. Of course, the beauty of the governor’s plan is that if you fail, you have only yourself to blame."

Of course your wallet will be lighter, and local food businesses will have less revenue; and if so, we'll have only the governor and the legislature to blame-and ourselves to the extent that they are our representatives. Let's hope that clearer thinking will intervene, and the budget will exclude any experiments in healthier living; we'll all be healthier as a result.


Here's a piece on the tax from the Democrat and Chronicle that highlights the growing opposition to the soda tax: "Foes of Gov. David Paterson's proposal for an additional 18 percent tax on nondiet sodas and other beverages are trying to beat back the idea, saying that it is unlikely to make people healthier and will cost jobs. "This is purely a money grab and ... at the worst time for middle-class families," said Craig Stevens, a spokesman for the American Beverage Association."

And there is a growing coalition of opponents to the idea: "The group is forming a coalition of business, labor unions and community advocates against the so-called "obesity tax" Paterson has proposed. Besides nondiet sodas, sweetened iced teas and other soft drinks, it would be assessed on fruit drinks with less than 70 percent natural juice."

Stevens went on to underscore that the tax is misdirected: "Instead of targeting the beverage industry, the governor should focus on educating the public on the need for moderation and more physical activity, Stevens said." Exactly so-and Paterson should concentrate on trimming the fat from a bloated state government; after all, that's what he is supposed to be in charge of.