Wednesday, January 20, 2010

Health Care Reform Dead? I Hope So...

I don't generally talk about politics on my blog with one exception: Health Care Reform. I think it's one point where politics and physical fitness intersect. I've been pretty critical of anything remotely called universal health care, single-payer, public option, or exchanges (In case you weren't paying attention, this is what the previous four is now called in the Senate Bill) because I don't think that the problem with health care cost spiraling out of sight could be solved by any reform in Washington DC.

I've stated numerous times that I believe that Americans are ringing up a collective doctors bill that we can't pay because of our rampant obesity. As I thought about it, that's not the whole problem but a root cause. Another key part of the problem is that some Americans think it's a right owed to them. I wouldn't be as concerned about America's obese medical bill if the average American would pay for their piece health care bill. Obviously, they can't. Instead, they treat it as an entitlement and expect the government to pay for it. The problem is that's 150,000,000-198,000,000 people, depending on which polling data you chose to believe. It doesn't matter whether we pay for it via the public or private sector. This is unsustainable because it's unaffordable.

About six weeks ago, The American Diabetes Association released a study which startled a lot of people. According Dr Elbert Huang, the number of diagnosed and undiagnosed cases of diabetes will balloon from 23,700,000 to 44,000,000 people by 2034. That would result in the cost of diabetes-related treatment going from $117,000,000,000 to $336,000,000,000.

This is alarming for sure but I'm even more concerned because I think that their 2034projection is too far away. They're assuming that 65% of the country will be overweight or obese in 25 years. By some estimates, WE'RE ALREADY THERE! Who is to say that these diabetes-related costs aren't just around the corner? Diabetes is a gateway disease, leading to a host of other, very serious medical problems. Who knows how much all of that could cost?

For those who don't pay attention, or are in a foreign country, Obama's, and the Democrat Party's, latest stab at health care reform that includes some form of universal coverage just hit a major stag with the election of a Republican, Scott Brown, to Massachussetts' vacant Senate seat. In fact, if Brown is seated in the Senate, it's unlikely that any health care reform gets passed this year, if ever.

If there's anything in the way of insuring every American through the federal government, I hope that it never happens. If it does, then there are two outcomes. The first is that the government will, by default, make it every American's right to be as fat as they want to be without consequence. Or, they'll give themselves the power to micromanage what Americans eat when it becomes clear to them that they can't provide adequate coverage for all of these fat people, much like what New York City Mayor Michael Bloomberg is doing with trans fats and salt or Obama wants to do with soft drink taxes.

If my opinion counts for anything, I think that the reform that should happen is that health insurance should operate like auto insurance. It should be there to cover major health care costs that are out of the control of the holder of the insurance plan. Routine maintenance things, such as drugs and doctor visits, shouldn't be covered by the plan. So, if a fat person wants to maintain their unhealthy lifestyle, let them pay for it and not pass the cost off on someone else. Furthermore, if they chose to live such an unhealthy lifestyle, they should have to pay more, just like bad drivers who get speeding tickets. They do the exact, same thing to smokers already.

I realize it probably won't happen but I have little doubt if fat people had to bear the costs of their bad decisions, they'd find a way to lose some weight. Here's to hoping!

9 comments:

pierini said...

This is a good and speedy blogflection after yesterday's message to Washington by the voters of MA.

I've said it often that the health care proposals of unsuccessful Presidential candidate John McCain were better and the way this country has to go because they promote competition and consumerism, both needed to reign in health care costs. The problem was that he (McCain) couldn't article his ideas well, the media wouldn't give him a chance to be heard, and those who were content with their status quo health coverage gave him a deaf ear.

As someone who has a high deductible health insurance plan costing over $800 per month with $4,000 per year deductibles for both my wife and me, I know all aobut medical health care consumerism and it has a huge impact on my lifestyle choices and the questions I ask (like "how much") before choosing a health care provider's service.

I said early in the game that I didn't think President Obama's health care reform, as originally proposed, would ever become law and based this on what I recall with President Clinton's failed attempt.

Let's both continue to hope so.

Sam said...

Setting up health insurance like auto insurance would be a terrible idea. Every credible health economist agrees that preventative care (i.e. regular check-ups with a doctor and prescription drugs to manage ongoing conditions) saves substantially more money than the current system we have. One of the reasons that healthcare costs are so high is that ER care is incredibly expensive in the U.S. and it makes sense when you think about it. It's far cheaper to give someone a cheap pill to manage their high blood pressure than it is to manage the heart attack and month long stay in the ICU that results. This isn't really a matter of opinion it's an empirical question.

Also, fat people do pay more for health insurance, that's what a free market dictates. If you're obese then you likely have accompanying health problems that make your premiums more expensive, thus the fact that you're unhealthy is reflected what you pay for insurance. And as I've said, making sure that overweight people have insurance is actually cheaper than leaving them uninsured.

Furthermore, your opposition to coverage seems to be based only on the fact that you're irritated with obese people for making poor lifestyle choices. There's a basic question of humanity to be answered. Estimates of the number of people that die due to lack of health insurance range from 27,000 to 40,000 per year. These are people that would be alive if they could afford health insurance. To often this debate ignores that simple fact. We live in the United States of America and somehow at the moment it's acceptable that at least 27,000 poor people die every year because they can't afford to see a doctor.

Thomas said...

Sam, you are so good with the stats I wonder if you would provide the breakdown of how many of the 27k - 40k who die each year, while not owning any health insurance, could afford to purchase said insurance and chose not to buy?

People die from heart attacks, drowning, massive trauma, gsw, toxic shock but not lack of insurance. (I know the point you are making but you are tugging at the squishy emotions so well I thought I would break your rules for shaming the oppo)

The treasury is bare. How does the gov intend to pay for all these good intentions?

Sam said...

That's a fair question, the upper bound of that approximately 40,000 number is taken from this study done by Harvard Med. School researchers: http://pnhp.org/excessdeaths/health-insurance-and-mortality-in-US-adults.pdf

However, on face value, that argument doesn't seem to hold water. It seems pretty reasonable to assume that if people are able to afford life-saving medical care, then they'll purchase it instead of dying. I don't know of any studies that ask that particular question, but if I can find anything I'll post is.

You're right that no one's cause of death is "lack of insurance", but I assumed that the distinction was trivial enough that it didn't need clarification. Still, people definitely do die from medical issues that remain untreated because of lack of insurance.

I'm not trying to fall back on an emotional argument here because I think the facts aren't on my side. I just think it's important to remember that there's a human side to this debate as well.

Finally, the bill itself will actually help reduce the deficit. Over the next 10 years it brings the deficit down by 100 billion dollars. That's not a huge number compared to a national debt of 12 trillion, but it's important to note that this doesn't increase our national debt in anyway. The bill is fully funded as it's written.

Anonymous said...

Though not an American myself, I've heard from American friends that for a lot of people junk food is the only food affordable to them.

If you're not willing to help them with their problems caused by being overweight how will you help them prevent becoming overweight and what with those for whom it's too late? If I may ask?

Justin_PS said...

Wow! There's been a lot of interesting points brought up and made.

The point that I was trying to make is that I believe that the reason why our health care system is on the verge of collapse has a root cause: we need too much of it to sustain a collectively unhealthy lifestyle. Look at those diabetes numbers. That is Diabetes ONLY! It's in the hundreds of billions of dollars... a 12 figure number. Just. One. Medical. Condition. $117,000,000,000.

How is shifting it to the government's responsiblity going to make it cheaper? Since when does the government do anything cheaper and more efficiently? Medicare? Medicaid? Both have run well over 40-times overbudget.

Dirty little secret: our health car isn't free market either. The government already subsidizes 41% of our health care. They heavily regulate who can-sell-what-where, what they can cover, what they can charge, etc. Call this whatever you want, but don't call it free market.

Back to my auto insurance analogy...

We all know someone who is obese and requires a lot of medical care. I know one who need weekly doctor visits, takes 4 prescriptions, and needs at least one procedure or minor surgery a year. This person is about 100lbs overweight. If this person had to pay for all of this, would they be eating poorly? They wouldn't be able to afford it!

Like Mr T said, the treasury is empty.

Oh, and the junkfood-is-all-they-can-afford line is 100% pure, organically-grown, and made in the USA... BULLSHIT!!!

It's very possible to eat healthy, if a person is knowledgable and motivated. Most people don't have the latter... at all.

Sam said...

Arguing that the reason healthcare costs are so high is because of obesity is a tricky proposition. It's true that people need more healthcare when they're obese. But that only looks at one issue. The prices of medical care in general is increasing at a far higher rate than other products. So while as a nation we are likely using more healthcare because of the obesity epidemic, we're also paying far more for that coverage than expected. At least part of the increases have to do with price and not quantity.

This is a quick primer on healthcare costs from the Kaiser Foundation (http://www.kff.org/insurance/upload/7670_02.pdf) and does a good job of showing that obesity rates are just one small part of the problem.

It's not necessary to make the actual provision of healthcare (i.e. Medicaid and Medicare) the government's responsibility. Subsidizing healthcare purchases doesn't mean that the government is the one providing healthcare. It just gives people money to buy healthcare that they couldn't otherwise afford, people receiving subsidies are perfectly free to find a new insurer if the one they have isn't doing a good job. That's the essence of the free market.

The argument that the government can't manage healthcare is a legitimate one. However, it's important to remember that it's legitimate because of flaws in our system of government, not because government writ large is unable to manage healthcare. This graph shows healthcare spending vs. life expectancy (http://blogs.ngm.com/.a/6a00e0098226918833012876a6070f970c-800wi). The countries with higher life expectancies than the U.S. all have healthcare systems that feature heavy government intervention. The flaw is with our government, not government in general.

Finally, having spent some time living in Scandinavian countries, I can speak from personal experience that they're healthcare systems are excellent and the graph demonstrates that they're cheaper than the U.S.'s as well.

Thomas said...

Sam says: "The argument that the government can't manage healthcare is a legitimate one. However, it's important to remember that it's legitimate because of flaws in our system of government, not because government writ large is unable to manage healthcare."

Government does not manage private transactions (healthcare provision). It regulates. It provides incentives for desired conduct (desired by who?). It punishes for deviation from regulations (even if deviation saves lives).

What is Government? A thing? People acting in the public interest? Folk employed at your expense without incentive to produce jack in return? Only incentive is to keep job (rule with exceptions).

To suggest that the gov does anything in your best interest is silly. Even national defense is not in "your" best interest. It is in the nation's interest. All systems of gov are based on involuntary compliance with it's man made framework of rules, laws and regulations. I would rather a relationship that impacts my health be voluntary in it's foundation. The details of this relationship agreed to through trial and error and continued agreement.

Our problem isn't fat folk. They contribute to the problem. The problem isn't insurance hiding the true cost of medical care. It is part of the problem. All these parts, and the many other unmentioned parts, are to be addressed by the interested parties voluntarily. The gov cannot exist if all relations and contracts are voluntary. This is why the gov wants to insert itself further in this area. To ensure survival of those dependent on your (my) tax dollars for income and influence.

By the way, there is no way a healthcare bill will lower deficits. Besides the key is debt not deficit. It is a spending bill. When spending is less than income then we reduce debt.

Deficit: Last month I gave out 9 IOU's. This month I only gave 8 IOU's. I have reduced my deficit. But I still haven't paid the 9 from two months ago.

Debt: I owe on 17 IOU's and can't pay them.

I the answer to increase debt? Really? House of cards!

Justin_PS said...

Tom, why don't you have a blog? I think you could get me interested in growin grass... if you wrote about it.

How about it?

Okay, I've had enough of politics... for a week or so. We'll be back to exercisin' soon @ the BWF's.