The syntax of sin taxes: Putting it together to improve physical, social, and fiscal health

摘要

The United States spends approximately 18% of its gross domestic product on health care, a proportion that far exceeds that of any other country and continues to increase. Unfortunately, this astounding expenditure is associated with suboptimal population health outcomes compared with other developed nations. The ever-increasing burden of . health care spending threatens the financial solvency of the nation and is currently the topic of intense policy and political debate. Current issues prominent in this debate include (but are not limited to) overuse rates for many services and procedures that are on the order of 30%, with marked regional variations in use that are unrelated to outcomes, Medicare and Medicaid spending as drivers of long-term increases in the federal budget, a large number of uninsured Americans, and marked health disparities based on race and socioeco-nomic status. A dominant and perhaps oversimplified theme in some policy discussions directed at improving the nation's health is that if issue number 1 were addressed there would be plenty of resources available to address issues 2, 3, and 4. For example, if the 30% overuse rate is in fact accurate, "solving" it would free up billions of dollars per year to address the other issues. However, efforts to make health care in the United States more efficient have been elusive, and even if politically palatable solutions were developed, they would take years to implement in the current diffuse, chaotic health care environment. Although contentious debates related to the complexities of health care costs and financing are ongoing (and beyond the scope of this Commentary), missing from many of these discussions is an appreciation of how behavioral factors contribute to disease (and health). Indeed, medical care is only a minor contributor to overall population health.