Something doesn't quite smell right

I want health care reform to pass. I really do. I think keeping the same system in place makes about the same sense as city planners returning to medieval ways of letting cities grow - all cobbled together without a broader sense of a plan.

I really want healthcare to be universal, and I acknowledge that there will be a greater burden on some than others when paying for this. It is my belief that people should be asked to pay commensurate with their income. I'm a socialist that way, I'll admit.

I do not, however, believe that a disproportionate burden for healthcare costs should be shifted to any particular group based on "healthy lifestyles." This is, I think, a red herring that makes people feel self-righteous, but is a horribly slippery slope.

I'm fat, so I am biased in this. I would, under the current version of the reform bill under consideration by the Senate, be required to pay more than thinner people who get the same insurance I do. I have a job, and I can afford to do this. In fact, because I have a job, I don't mind paying a bit more for my healthcare. It's that important to me to have everyone insured.

But by asking all people who live "unhealthy lifestyles" to pay more for health premiums, we begin to head in the direction of system that penalizes people who do not have societal access to what's considered "healthy." How do you tell a woman who is holding down two jobs to support her children that she needs to head to the gym or go for a walk when she can't afford gym membership or her neighborhood is not safe...even if she had the time and energy to do these things? How do we justify penalizing a family that lives in a neighborhood without access to healthy food choices (i.e. safe neighborhood grocery stores with affordable fresh produce).

Even the underlying assumption feels offensive to me. The idea behind this part of the debate is that we want to keep costs low, so we need to penalize those groups we think can do something about their potential for health related problems because they might cost more. It is easy for people to believe that this will only affect people who are fat or who smoke, but it opens the door for invasion into other habits as well. People who have unprotected sex open themselves to STDs and pregnancies. Those who engage in high-injury sports (including football, hockey, soccer) open themselves up to orthopedic injuries and the possibility of early onset dementia from head trauma. Where will we draw the line? Who gets to decide.

The reality is that most of the rising costs of healthcare have to do with the aging of our population. The older you get, the more you need healthcare. The greater burden you become on the system. Perhaps we should start trying to determine who is going to live the longest and charge them more now, on the off chance that they will live to 95?

We need healthcare for all people, but we need to think about the way that we are organizing the provision of it with an eye to long term consequences.