Krugman, who bemoans "an ideological landscape tilted in the direction of doing nothing," seems to recognize that most Americans are not quite prepared to accept the idea that every health issue is a public health issue. "One answer," he writes, "is to focus on the financial costs of obesity."
Krugman does not distinguish between the voluntary risk pooling of private health coverage and the compelled subsidies of Medicare and Medicaid. Yet private insurers are free to charge fat people more, and their customers are free to shop around for a better deal if they don't like the terms of their coverage.
By contrast, government-supported health care imposes the costs of fat-related illnesses on people who have not agreed to the arrangement and cannot opt out. But even here, the net financial impact is unclear. If overweight people tend to die earlier and therefore draw less on Medicare and Social Security in old age, fatness may save taxpayers as much as or more than it costs, as seems to be the case with smoking.
More important, the implications of the argument based on taxpayer-funded health care are just as alarmingly open-ended as the implications of the "public health" argument. Perhaps sensing this, Krugman assures his readers "nobody is proposing that adult Americans be prevented from eating whatever they want" -- which, given the aims of anti-fat activists who support "junk food" taxes, simply isn't true. Nor is it reassuring that in a subsequent column, Krugman says overeating is one of those "situations in which 'free to choose' is all wrong," since "even adults have clear problems with self-control."
The one encouraging sign is that Krugman describes himself as overweight even as he urges his fellow Americans, most of whom are also overweight, to support a government campaign against gluttony and sloth.
People will be forced to consider how that effort might affect their own lives -- and whether they want to live in a country where their unhealthy habits are everyone else's business.