Cap and Trade to Improve Dietary Habits

Kristina Lewis and Meredith Rosenthal have a provocative suggestion in this week's New England Journal of Medicine.  Instead of taxing non-nutritious food -- new taxes face seemingly insurmountable political opposition -- they propose establishing a "cap and trade" regime that depends on the free market, much as we have done for sulfur dioxide emissions.  Cap and trade has allowed us to decrease sulfur dioxide emissions by about half, and it's cost far less than standard emission-lowering regulations would have.

The idea is straightforward -- create a target for the total amount of harmful food products, and allow individual manufacturers or marketers to sell to each other the right to incorporate more fat, more calories, or more salt in their products.  That would allow full, free consumer choice, but would tend to increase the prices of unhealthy food while decreasing the prices of healthier alternatives.

Some will consider this a back-door attempt to tax unhealthy food - but it's not.  Obesity and diabetes caused by poor dietary habits have real social consequences and costs; this proposal would be an innovative way for the government to structure a market to improve our health and lower our health care bills.

Salt Reduction and Cost Savings

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The New England Journal of Medicine published a computer simulation online late this week showing that salt reduction would reduce new onset of heart disease by 1/3 and stroke by almost half -- saving between $10 and $24 billion dollars of health care costs annually.

As we've seen, changes to the payment system are complicated and difficult to implement - since there is always a loser as we move to lower unit prices, or insist on more accountability from various parties in  the health care system.  Changes to the delivery system are even more difficult.

This is another example of a public health intervention being cost saving -not merely cost effective. The intervention is not free. Regulatory effort is necessary, since a large portion of the sodium in the American diet comes from processed food.  The authors estimate that salt reduction would yield between 200,000 and 400,000 QALYs annually - with cost saving as opposed to incremental costs.  The authors note that this is substantially better value than antihypertensive therapy for those with hypertension -which at between $6,000 and $26,000 per QALY is also a very good value!

We need to reform health care payment and health care delivery - but that seems further away today than last week.  Let's not forget the value of public health interventions as we contemplate making health care more affordable .  I'll be skipping salt from now on, too.