Is the West's reckless lifestyle killing our poorer neighbors?

[Africa, with Tanzania highlighted]

I spent all day Monday in an outpatient clinic (I'm fine; thanks for asking). I met a lot of nurses, and every one of them was excellent.

When Velda came to take away the remains of my lunch, I offered her my untouched can of ginger ale.

"I don't drink soft drinks," she replied. Since I rarely do either, we started chatting.

Velda grew up in Tanzania, moved to Belgium, spent several years in London, and finally came to the United States. She returns to Tanzania regularly, and she is not happy with what she sees.

"I grew up eating lots of vegetables," she told me. "We might have had ice cream once every three years. But now people are eating American-style junk food. They don't know it's not good for them."

Tanzania's cigarette industry is big. In spite of national bans on most forms of advertising, Velda vividly recalls a huge billboard for Sportsman - one of Tanzania's most popular cigarette brands - right across from a school entrance where children can't help seeing it every day. And the children are smoking - she's seen them.

Supposedly regulated drugs are easy to buy without a prescription. Velda's 18-year-old nephew, once an honor student, is now a prescription-drug addict and a drop-out.

"The thing is," Velda said, "there's no way to get treatment for most diseases. It's not like here. If people want to be healthy, they have to take care of themselves. When they get sick because of junk food or smoking or drugs, they just die."

I checked the statistics. Tanzania's per capita income is $1700 in U.S. dollars. There is one physician for every 125,000 people (compare America's ratio of one physician for every 375 people; or Cuba's of one for every 156). Tanzanians live, on average, to age 53. Velda's twin sister died at age 23.

Velda, who is a kind and gentle nurse, gets angry when she thinks about what's happening to her people. "Why?" she kept saying. Why are international companies so aggressively promoting foods and cigarettes and drugs that will shorten people's lives and even kill them? Why is nobody stopping them? Why?

Mr. Metz's 5% health-insurance surcharge

I'm having trouble understanding today's news about "Florida based restaurant boss John Metz, who runs approximately 40 Denny's and owns the Hurricane Grill & Wings franchise." According to an article in the U.K.'s Mail Online, Mr. Metz "has decided to offset [the extra cost Obamacare will bring] by adding a five percent surcharge to customers' bills and will reduce his employees' hours."

Here's what scares Mr. Metz: By 2014, Obamacare will require employers (of more than 50 workers) to provide adequate health insurance for full-time employees or risk paying a penalty (you can learn the details at the Kaiser Family Foundation's website).

If he's scared, it must be because his restaurants do not provide adequate health insurance for their full-time workers. Actually, Denny's does provide what their New Employee Enrollment Guide calls "affordable limited benefit medical plans to all eligible employees." (That was from their guide for hourly employees; salaried employees also get health insurance.) Is Mr. Metz ignoring Denny's benefits package? Or does he believe that the insurance is so inadequate that employees will choose to get insurance elsewhere? Or are his workers paid so poorly that they can't possibly afford even the low-cost option? Or does his own chain, Hurricane Grill & Wings, not offer this benefit at all? Because if he's providing decent health insurance that his employees can afford, he will not have any extra charges and so has no reason to add a surcharge to his meals.

So why is he adding a surcharge and downgrading his workers to part-time status?  According to Fox News, "To further offset the costs, Metz, who oversees roughly 1,200 employees as president and CEO of RREMC Restaurants, LLC, said he also will slash most of the staff's time to fewer than 30 hours per week." If Mr. Metz is providing inadequate insurance - or no insurance at all - to his full-time employees, I can understand why he would want to make all jobs part-time. That way he would face no government penalties for his miserable benefits policy. But if by reducing hours (and hurting his workers even more than he's already doing) he manages to escape the penalties, then why is he adding the surcharge?

Mr. Metz seems to be sending the message that he hates Obamacare. He may not realize it, but he's also sending the message (whether true or not) that he's a rotten employer who provides inadequate employee benefits, would rather cut workers' hours than be required to treat them humanely, and then is willing to make diners pay more for supposed additional costs - even though he has managed not to incur them.

I was going to end there, but then I got to thinking: maybe this isn't only about Mr. Metz. Maybe he really can't give his workers adequate pay and benefits and still stay in business. Maybe this is really about us.

We Americans in the upper 53% have relatively inexpensive houses and cars and clothing and groceries and restaurant meals (when compared with the rest of the world). We manage this by sending much of our manufacturing overseas and by paying squat for services

The people who grow our food, process our meat, bring the food to our tables, wash our dishes, clean our offices, and care for our aging parents often do not earn enough to support their families and must rely on tax-supported programs just to survive (in Florida, Mr. Metz's home state, a person working two 24-hour-a-week minimum-wage jobs, 52 weeks a year with no time off, would bring in $19,144 before payroll taxes; in neighboring Georgia, where Mr. Metz has a few restaurants, the minimum-wage two-job worker would make just $12,854).

But we Americans have relatively low taxes - which means that our social safety net has a lot of holes in it.

Did you know, for example, that "Wal-Mart's poverty wages force employees to rely on $2.66 billion in government help every year, or about $420,000 per store[?]. In state after state, Wal-Mart employees are the top recipients of Medicaid. As many as 80 percent of workers in Wal-Mart stores use food stamps" (check it out here).

So what happens to these underpaid workers if we continue to demand lower prices and lower taxes?

Obamacare, though it needs improvement, is an important step toward justice. Mr. Metz's surcharge could be another step in the right direction if it enables him to insure all his employees.

However, if diners reduce their tips by the amount of the surcharge, restaurant workers will end up with even less take-home pay than before. If Americans continue to push for lower taxes, more and more of the working poor will fall through the safety net. And if Mr. Metz goes ahead and reduces the hours of his full-time workers so that they won't qualify for health insurance, the extra 5% will go directly into his pocket.