InFatuated With Healthcare

One of the main reasons why health care costs are so expensive is because Americans are too fat-something that Allysa Finley points out in the Wall Street Journal, isn't addressed in the current legislation: "While lawmakers like to vilify insurance and pharmaceutical companies for driving up health-care costs to make fat profits, obesity is actually a far bigger reason for ballooning costs. Call it the obesity bubble, and a study out this week shows that it's in no danger of bursting...Unfortunately, the pending health-care legislation in Congress isn't going to help reduce obesity-related costs, despite the supposed increased emphasis on "prevention."

But why not? Well, it seems that there's more sensitivity to the overweight than to the idea that others should pony up for large numbers of people behaving badly: "What's more, the House legislation specifically bars incentives for Americans to lose weight. The National Association to Advance Fat Acceptance (NAAFA) lobbied against provisions that would help businesses use financial incentives to promote weight loss. The NAAFA also opposed allowing insurers to use a person's weight or BMI to differentiate rates or deny coverage. With two thirds of the population overweight or obese---and that share is predicted to increase to at least three in four in the next 10 years---a slim portion of the population is going to be bearing disproportionately the health-care costs of the large majority. That's a fat tax on thin people."

There is, however, this nugget in the bill: " Sure, there's a provision mandating that chain restaurants include calorie counts on their menus, but two scientific studies have come out this year demonstrating that New York City's calorie labelling law hasn't had a significant impact on people's caloric intake. People see the information and then usually choose to ignore it."

What we have, then, is the existence of a public health ideology that seeks to force everyone to pay for the unhealthy habits of others-whether the burdensome, expensive and ineffective calorie posting reg, or a tax on soda. While we are opposed to the government's mandating of behavior, there's nothing wrong with insurance that assesses risk.

But this isn't happening with today's third party insurance plans: "Because of the nature of our third-party payer health-care system, the costs of obesity aren't just borne by the over-eaters. This can result in the demonization and scapegoating of overweight people ("I wouldn't be paying so much for health care if you didn't keep eating Cheetos!). No one likes to feel that they're picking up the tab for other people's unhealthy behaviors, but most people don't like to feel that they're unfairly costing other people money either."

But imagine when the government gets to control the whole enchilada. With no pre-existing conditions as central to the public nature of the plan, you have a particular mindset embedded that looks to avoid stigmatizing-and also parceling out costs in any kind of equitable manner: "The public option, expansion of Medicaid, and government health-care subsidies will just exacerbate these resentments by making the costs of obesity more dispersed among the public. As Marilyn Wann, author of "Fat! So?" and a strong advocate of the public option, notes "We're all in this life raft together."

But if there are too many people like Wann, the raft won't float! And what's missing from these healthcare proposals are decent incentives to promote healthier behavior: "Obesity has become a collective action problem with people failing to take positive action because they don't reap the benefits. If Americans were told that they could save $821 a year by maintaining their current weight for the next 10 years, most people probably would. If told that they could double those savings by dropping 20 pounds, most probably would. So why don't they? Because they don't have any skin in the game. If they lose weight, they don't reap the financial benefits through lower insurance premiums, though they may reap the health benefits. Unfortunately, for many people, that's just not enough."

So, as Finley tells us, the solution isn't with menu labeling or soda taxes. The rational approach is through imposing a cost/benefit equation that elevates personal responsibility: "People are remarkably receptive to financial incentives. A 2006 survey of CEOs by the Conference Board, an organization that collects and analyzes business information, reported that wellness programs yield up to $5 of health-care savings per dollar invested. CEOs noted that awarding employees who drop weight with cash, extra vacation days, and insurance rebates has helped them reduce their health-care costs."

Basing insurance on risk surely isn't a new concept; but the way the current legislative dance is going, it looks as if the only risk that's in play is the one that devolves from the dangers of a mounting national debt. We'll give Finley the last word: "And no doubt such incentives could work on a national scale with insurers offering reduced premiums or rebates to individuals who maintain a healthy weight. But the House health-care legislation prohibits such incentives because it is "discriminatory." That's right. It is price discrimination. Health care shouldn't be a buffet where everyone pays the same amount no matter how much they consume, though that seems to be what Congress wants. But we all know the problem with buffets. It's too easy to consume too much."