To many, Robert F. Kennedy Jr. appears to advocate positions that are contrary to scientific orthodoxy, but there’s one area where he and his critics largely agree: Healthier eating leads to a healthier population. Obesity, for instance, is a major and costly health problem that is only getting worse. Excess body fat and obesity are linked to type 2 diabetes, coronary artery disease, and hypertension, among other ailments. One study found that about 90% of adults with type 2 diabetes were either overweight or obese. In 2022, the U.S. spent more than $300 billion on medical care for those with type 2 diabetes, which is about 7% of the total amount the country spends on health care annually. More telling, though, is a 2020 report from the Milken Institute reporting that the annual cost of obesity in the United States exceeds $1.4 trillion, or about 34% of the $4.1 billion spent in the U.S. on health care in 2020.
Americans have been paying for other people’s unhealthy lifestyles for quite a while — first drinking alcohol, then smoking cigarettes, and now eating foods high in sugar. With the Affordable Care Act, the amount that the mindful pay for the obese is increasing. An order of magnitude more money is spent on obesity-related diseases than all of the fraud in our health care system.
If this were France or Japan, the central government would dictate that everyone must be thin, and by golly, everyone would be thin. That occurred in France more than 100 years ago through government policies requiring new mothers to take courses in portion control and programs that strongly discouraged eating between meals or allowing children to eat their meals alone.
The French experience, with its heavy dependence on centralized control ( “If Paris says it is good, it must be good and must be obeyed”), is not likely to work in this country. We are at a loss to figure out what will work and what to do about something everyone recognizes is a national problem with a substantial price tag. Kennedy’s idea of banning the purchase of sugared soft drinks with food stamps is a small step in the right direction. But we don’t know what else would work and be sustainable.
To find out, I have an unusual proposition that would require modest legislation: Ask one of the heftiest states to participate in a study with a huge carrot at the end. I like to think of it as the No Child With a Behind Left program.
The state with the highest obesity rate is currently West Virginia. In 2023, about four out of every 10 West Virginians were obese, and more than two-thirds of the state’s population was overweight. Many other states are very close behind West Virginia in terms of obesity.
Under the proposal, if West Virginia can reduce its obesity rate to under 25% (the rate in Colorado and Hawaii, our leanest states, but significantly higher than the 17% rate in France) in five years, then no one in the state would have to pay individual federal income tax for up to five years provided that the obesity rate stayed under 25%.
This proposal has a number of virtues.
First, West Virginians would likely attempt to use various strategies to meet the 25% goal — some would work, and some would not. The rest of the country would learn from West Virginia’s experience.
Second, the experiment, whether successful or not, would not cost much. About 47% of West Virginians receive their health care through either Medicare or Medicaid. The federal government pays about $4 billion in Medicaid payments to West Virginians per year and another $7 billion for West Virginians on Medicare. Thus, the government pays about twice as much on Medicare and Medicaid in West Virginia (about $11 billion annually) than West Virginians pay in federal income tax (about $5 billion in 2023).
Transforming a fat West Virginian into a svelte one would dramatically reduce those Medicare and Medicaid costs and improve corporate productivity within the state leading to greater corporate tax revenues. In 2021, according to KFF, the annual health care costs incurred by an obese or overweight individual with private insurance was $12,588 compared with $4,699 for someone who was not overweight.
Thus, excess weight costs nearly $8,000 per annum per person; the average West Virginian family pays approximately $6,850 in federal income tax. If one assumes that the private-side differential approximates the Medicare and Medicaid experience, then if one person in a family of two were to cease being obese or overweight, the $8,000 savings would more than compensate for the $6,850 loss in federal income tax for that family. However, not every family has an obese member and not every family has a member on Medicare or Medicaid, but with an obesity and overweight rate of more than 66%, the average family of two has 1.32 individuals who are overweight and about a 0.47 chance that that person is covered by either Medicare or Medicaid. The direct savings on health care to the federal government alone would be about $3,700 for a family of two equal or about 55% of the loss on federal income taxes. This doesn’t take into account savings on employer-based insurance or subsidized insurance under the Affordable Care Act.
In addition to improving health, the proposed program would provide West Virginians with an economic incentive to reduce their weight. American ingenuity is at its peak when avoiding federal income tax. This proposal harnesses that ingenuity allowing the rest of us to learn from West Virginia’s experience.
Robert P. Charrow was the general counsel of the U.S. Department of Health and Human Services during the first Trump administration.