Sept. 10 (Bloomberg) -- I’ve finally figured out the Republicans’ philosophy: If President Barack Obama is in favor of something, it has to be wrong, even if they once believed in it.

Save the economy from collapse by propping up the banks, which former President George W. Bush did to a fare thee well? That’s now socialism. Talk to school children about turning off video games and doing their homework? That’s “creepy” and Orwellian, indoctrinating the young as if they are guinea pigs.

For suggesting that doctors should be reimbursed for end- of-life counseling, something previously supported by Bush and former Alaska Governor Sarah Palin, Obama is going to throw grandma from the train.

If the president is for death panels, fat panels can’t be far behind. Not exactly. But grab yourself a Dr Pepper and a Ho Ho and calm down, if that’s possible on a sugar high. Every expert says that health-care reform must address obesity, where medical costs have increased with the national waistline -- up 37 percent since 1998 to $147 billion in 2008.

Those who are overweight spend $600 more a year on drugs. A recent study out of California pinned its budget problems on the $41 billion cost of “obesity and inactivity.”

Yet a broad effort to link obesity and health-care reform has retreated to a modest soft-drink tax, which Democrats tend to favor and Republicans, led by the ranking minority member on the Senate Finance Committee, Charles Grassley, tend to oppose. In the committee, where members snack on chips and Coke during their marathon health-care negotiations, Grassley dismisses a levy on sweetened drinks as a “nuisance tax.” Grassley was the first senator to follow Palin down the death-panel hole and kill end-of-life counseling.

The Thin Man

The politics are dicey for Obama, who is too thin to talk about anyone being too fat. He may have never touched Doritos in his life, rejected anything sweet on the campaign trail, and offers White House visitors an apple instead of a bowl of candy. It’s easy to tag him as just one more elite forcing arugula on those who prefer their Big Macs with a double order of fries.

Obama has left most of the fat talk to his health-care team since the campaign, when he addressed the obesity issue squarely in one debate and said that “if we could go back to the obesity rates of 1980 we could save the Medicare system a trillion dollars.”

In this month’s issue of Men’s Health magazine he says, “it’s not as if people have to completely transform their lives” or be sent to “boot camp.” In others words, Mr. Thin isn’t telling anyone to diet. His point is that buying fresh vegetables and fresh fruit in supermarkets and getting pizza and tater tots off the school cafeteria menu is an excellent idea.

Flat Tax

A soda tax, he added, at a paltry 3 cents per 12-ounce serving, which would raise $24 billion over the next four years, should be “explored.”

Obama’s head of the Centers for Disease Control and Prevention, Thomas Frieden, is all for it. At a CDC conference on obesity last month, the study most frequently cited was from Health Affairs, a leading peer-reviewed journal on health policy. It concluded that “obesity is the single biggest reason for the increase in health care costs in the United States.”

About a dozen states already have a soft-drink tax to save on medical costs, although an 18 percent surcharge recently proposed by New York Governor David Paterson fizzled.

Be Civil

If health care hadn’t gotten bogged down in insurance reform, we might be able to have a civil conversation about containing costs by reducing obesity. There are parallels between obesity and smoking. Both kill prematurely, although tobacco is purely a choice and being overweight is only partly one as the more corpulent in my family keep telling the more svelte in my family at every holiday meal. Taxes on Marlboros did reduce consumption, and so would taxes on Coca-Cola.

What’s more, the tax would just be a drop in the bucket compared with the subsidy for high-fructose corn syrup. The syrup is used to sweeten the likes of Mountain Dew, a soft drink that costs about the same as a gallon of milk, never goes sour and thus is the drink of choice in Appalachia, where there’s an epidemic of rotten teeth.

One political problem is that the tax on sweets would fall disproportionately on the poor. An array of perversities make it cheaper to eat badly than well. A dollar can buy 875 calories of soda or 1,200 calories of potato chips but just 250 calories of vegetables or 170 calories of fresh fruit, according to a study in the American Journal of Clinical Nutrition.

States with the most obesity are among the poorest -- Mississippi, Alabama and West Virginia. They are also the states most likely to be hostile to government intruding on something as personal as dinner. Posting calories on a restaurant menu, as New York City now does, would get you run out of town in Biloxi, Mississippi.

In the thousands of words in Obama’s speech last night, nowhere did he mention the real elephant in the room. He left $147 billion and America’s fat people alone.

(Margaret Carlson, author of “Anyone Can Grow Up: How George Bush and I Made It to the White House” and former White House correspondent for Time magazine, is a Bloomberg News columnist. The opinions expressed are her own.)

To contact the writer of this column: Margaret Carlson in Washington at mcarlson3@bloomberg.net

Last Updated: September 9, 2009 22:13 EDT