Big Soda, Big Government, and Other Kinds of Carrots

Remember when Coke came in those heavy green glass bottles? They held only 6.5 ounces of the iconic American beverage, which seems like a thimbleful in comparison to the bottomless vats of soda available in fast-food restaurants.

Howls went up last month when New York Mayor Michael Bloomberg announced a plan to impose a 16-ounce size limit on soda and sweetened beverages served in restaurants, theaters, sports arenas, and sold on street carts. A Reuters/Ipsos poll shows that two-thirds of people surveyed oppose the ban.  Coca-Cola called the proposed ban “insulting to the American people,” but there may be more concern about insulting Coke shareholders if other cities follow New York’s lead with a resulting drop in sales.

On the other hand, a chorus of doctors battling the diabetes epidemic is calling for even greater regulation, not only of soda but also of all unhealthy food. According to the American Medical Association, sugar-sweetened drinks make up nearly half of Americans’ added sugar intake. Denmark, Finland, and Hungary, hoping to stave off an American-style obesity scourge, have raised taxes on foods high in fat, salt, sugar, and caffeine. Ice cream, chocolate, butter, chips and other high-calorie, high-fat foods come with hefty excise taxes in those places.

Would that work in the U.S.? Unlikely. If we’re already in a lather about the government’s mitts on our Big Gulp, I can’t see the American public signing on for Twinkie taxes. Why not look at a bigger picture of health and put a system in place that relies on bonuses instead of bans?

Flip the whole concept on its head and give people cash when they make measurable steps toward good health, rather than wasting time and energy on bans that won’t work. Make the program robust, with rewards that count, like a $25 incentive for people who move their weight, blood sugar, cholesterol, or blood pressure in the right direction, and another $25 at specified intervals for continuing or maintaining the improvement.

A few medical groups have piloted a patient reward program, but timidly, with lackluster incentives such as a small gift card for coming in for a checkup, or a discounted gym membership for completing a health assessment survey. Patient response has been tepid. It’s time to roll out a program that is tied to real, measurable results, that doesn’t decide for the patient where rewards have to be spent or redeemed, and that is widely promoted through employers, insurance plans, and medical groups so that all eligible patients know about it and can take part. 

The concept of rewarding patients fits with pay-for-performance programs for physicians, which reward doctors for improving patient safety and health outcomes. The performance measures for doctors rely on evidence-based clinical guidelines. Shouldn’t patients share the financial reward for getting healthier? Employers and insurers, who stand to save a fortune when employees and members have lower rates of heart disease, diabetes, and other illnesses that can be avoided with lifestyle changes, could pool the incentive funds. Corporations like Coca-Cola, Pepsi, McDonald’s, and KFC could take part—all are major employers. With an incentive plan like this, these purveyors of high-fat foods and sweet drinks wouldn’t exactly be paying their employees not to consume their products, but perhaps to eat and drink them moderately enough to stay healthy.