Beyond Labels

A 360° Discussion of Foreign, National and Local Policy Issues

The Miller Plan and some data that might support it

As our last meeting, Scott proposed that we could lower health care costs by motivating people–by an income adjusted tax or premium on health insurance payments–to follow good diets and to exercise. I thought it was a great idea, and dubbed it “The Miller Plan”

I thought this was a great idea, and dubbed it “The Miller Plan”

Below I’ve linked to a video giving a great talk about the reasons for the high cost of medical care. Brawley is Chief Medical and Science Officer of the American Cancer society.  (Profile here)

At the end of the talk, he provides some evidence in support of The Miller Plan. He tell us that obesity, high caloric intake, and lack of physical activity–it’s a three-legged stool–is the number two cause of cancer in the United States. Right now smoking is number one. And as smoking continues to decline, it will become the number one cause. It also causes many other adverse (and expensive) health outcomes. Elsewhere he points out that it disproportionately affects certain populations. About 50% of black women, he says, are obese.

The link is to the part of the talk that is relevant to the Miller Plan. If you are interested, you can move the slider to around 2:00 (skip the intro and watch the whole thing) I encourage you to do so. It does not suffer if you use the Settings (gear icon) to watch it at 1.5x speed or even faster if you can keep up.

Here’s another talk by Brawley. Covers some of the same territory, and some new as well.

h/t to Dr. Michael Murnik at BHMH for turning me on to Brawley.


  • Dr. Brawley’s talks are excellent. Thanks to Mike for posting them.
    I agree with the Miller plan to reduce obesity, increase exercise, stop smoking, etc. Indeed, this now is a wide-spread feature of employer sponsored insurance. (Jackson Labs does a very good job with this and provides substantial reductions in employee costs when they participate in various healthy exercise/diet programs.
    The problem is that these health risk factors are most prevalent in low-income people who are most likely not to have employer health insurance and who would not be helped by tax breaks. There needs to be another form of incentive for this population and my belief is that universal coverage where everyone has access to affordable preventative services is the answer. The ACA makes an attempt to do this, but I think some sort of “Medicare for all” approach is the most affordable and most practical solution.

    • Too bad you weren’t with us on Monday. The underlying premise of my comment was that all of the plans you mentioned in your second para above are focused on early detection more than encouraging (at least what we currently think is) healthy living. Other than compensating medical professionals to tell Medicare patients to eat their veggies and exercise, there don’t appear to be many incentives built into the system.

      We discussed the form of incentives (and penalties) at some length. Not that I’m an advocate of them, but income-scaled penalties (just enough to change “enough” of the population’s behavior) could be used up and down the economic spectrum.

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