Who's really to blame for our healthcare mess?

Take a look in the mirror. It may be you.

That is, if you're one of the millions who are considered obese, then you're also playing a role in the whopping $147 billion annual cost to our health care system. That translates into $1,250 per household. And, it's mostly accounted for in taxes and insurance premiums... which we all have to pay for.

Let's face it.  Our American society is fat. And, this single factor alone is bending our healthcare system to a near breaking point.

So far, the debate over healthcare reform has revolved around how insurers, drug companies, doctors, nurses and politicians/bureaucrats should be persuaded to change their behaviors (and costs) for the common cause. No doubt, some of that is needed. But, I find it interesting that very little is actually said about how those unhealthy, obese Americans should be forced to change theirs as well.

We all know that too much extra weight is a sure fire cause for diabetes, high blood pressure and heart disease. All of which cause early deaths. But, did you know that the Institute of Medicine has estimated that while genetics is responsible for 30 percent of these early deaths, the biggest contributor (at 40 percent) is behavior?

So, if this is the case, should we expect Americans to take on more personal responsibly for staying fit and keeping our healthcare system... healthier?

It seems only logical to me.

The problem is that obesity isn't viewed like other vices such as smoking or drinking alcohol. When either is consumed (or smoked) in excess these days, our societal norms typically force moderation (family, friends, etc.) to set in. If that doesn't happen, certain rules (i.e. being able to get life insurance) and/or laws (i.e. not being able to smoke anywhere in public these days) often provide the same outcome.

Go visit an all you can eat country buffet in rural West Virginia at dinner time. You'll see that the exact opposite norm exists there. Customers are encouraged to pile their plates three or four times with the most fattening of foods, and, that's true just about everywhere you go across middle America.

I don't have a healthcare protocol solution for this problem. And, I certainly am not advocating making anyone who is overweight pay more for his/her own healthcare. (Maybe a positive financial incentive would actually work better.) But, I would suggest that our society has to change what we now consider acceptable norms (i.e. over eating) pretty quickly.

To improve both their health and well being and to play an important role in fixing our broken system, it's time that we outwardly frown on these behaviors that elicit this outcome.

This means that a whole lot of self control has to take over as well. Normal sized portions of meals, learning to actually work out to burn off excess calories and eating better and, healthier foods are the ways to go. Although it might throw a monkey wrench into the unhealthy lives of millions, at least they will be alive to complain about it.

Comments

[Steve Shannon]

While I agree with you're argument, you're mixing and matching. Health Care is not quite the same as Public Health though no doubt the two are inextricably linked. On a side note, no need to head to take shots at West Virginia and middle America, I've seen plenty of all-you-can-eats and obese folks in New Jersey too.

[ed]

Thanks, Steve.

Technically, they are different. But, your other point is what matters. The two are completely linked and millions of obese people creates more cost to our healthcare system.

My apologies to West Virginia. New Jersey is one fat state, too.

[Bubbles]

While NJ has plenty of over weight citizens, statistically, there ARE more obese people in the south. This, from a recent article in Time magazine: "...eight of the 10 fattest states are in the South and it has more to do with Southerners' lack of physical activity rather than the food."
http://www.time.com/time/health/article/0,8599,1909406,00.html

[Steve]

Bubbles,

Interesting link. If that's the case, why does my company pay higher health insurance premiums because we're in NJ? We've been told, point blank that our health care costs are higher because we're in NJ then they would be states in the south or midwest.

And I agree w/you Ed...maybe it's time to try positive incentives. For example--if you maintain your weight or BMI w/in a healthy target range, you get a rebate or reduction on health insurance premiums. That is morally no different than getting a reduction in car insurance costs for having antitheft devices, taking a defensive driving course, or in the case of some insurers, going X months w/out a ticket,accident, or claim.

[Bubbles]

Well, Steve, probably because it costs more to be treated at a Newark Hospital than at a WalMart walk-in clinic in Possum Trot SC.
Almost two years ago I ditched a 35-year smoking habit. I feel the benefits every day and know I will never ever smoke again. Am I a healthier employee? Yes. But, I quit for my own well being, not because I had any financial or business-related incentive. However outside forces such as societal pressures, advertisements against smoking and limited public places to smoke, did have an influence. Fact is, you cannot pay people to be healthy. Folks make their own choices for their own reasons, and the US needs to attack the obesity problem head-on and give it the same focus as other ills of society such as smoking and drunk driving.

[Leah Hardesty]

I totally agree with you Ed and this debate is one that should be in the public eye because pursuing preventive care and making healthy choices are undoubtedly linked to health care. Case in point: if everyone had regular teeth cleanings and brushed teeth regularly, you could avoid having any costly dental work down the road. Taking care of your body BEFORE there becomes a problem reduces overall health care costs. You make the point that eating healthy and exercising on a regular basis helps reduce health risks, but it also improves all aspects of one's life. You have more energy and endurance. You learn to enjoy and appreciate nature and the outdoors. You realize physical exercise is a great way to make friends or spend quality time with your kids. And you realize an inner strength, both mentally and physically that you never thought you had. Americans would be happier in general if they just ate better and went out for a walk every once in a while. If this happened, if everyone did this, then business would soon follow the demand and we would see less of the JUNK on grocery shelves and restaurant menus, and more meaningful cuisine.

[Steve]

Bubbles, the proper comparison is between treatment costs at a Newark hospital and between the costs at, say, the hospital in Fayetteville, NC. (Which by the way is a superb hospital--I owe them by father's life.) Now, perhaps on a per visit, it's higher to go to Newark--higher cost of living, salaries, etc.--but if on average North Carolina folk are heavier, and therefore more prone to chronic illness, than people in northern NJ, the per capita cost to insure in NJ ought to be lower: we consume less services.

For it's worth, I suspect that particular issue is just insurers figuring that people in the NE can and will pay more...the same reason that Americans are charged more for drugs by U.S. pharma companies than people in other parts of the world are charged. (I personally find this sort of differential pricing offensive, since I have not volunteered to have my family's money subsidize others' health care.)

In terms of paying people to be healthier--why not? We pay people to drive more safely; we implicitly pay them (through better credit ratings, lowering borrowing costs) to be responsible consummers of credit; we even pay couples to get married, through more favorable tax treatment. There's nothing immoral or improper about offering an economic incentive for desirable behavior. As you note, that won't work on everyone--people make their own decisions at the end of the day--but if we think that society as a whole will benefit from healthier living, why not offer an economic incentive? If it swings some behavior (and it's not an overally generous incentive), it'll be worth it.