Wednesday, July 29, 2009

Updated: One Reason Why Socialized Medicine Scares the Bejeebus Out of Me

Interesting stuff todayyesterday out of the medical journal Health Affairs. As the AP summarizes:
WASHINGTON — Obesity's not just dangerous, it's expensive. New research shows medical spending averages $1,400 more a year for an obese person than for someone who's normal weight. Overall obesity-related health spending reaches $147 billion, double what it was nearly a decade ago, says the study published Monday by the journal Health Affairs.

The higher expense reflects the costs of treating diabetes, heart disease and other ailments far more common for the overweight, concluded the study by government scientists and the nonprofit research group RTI International.

RTI health economist Eric Finkelstein offers a blunt message for lawmakers trying to revamp the health care system: "Unless you address obesity, you're never going to address rising health care costs."
The data appear to be interesting and commonsensical, and I, being completely untrained in health policy and economics, certainly won't try to refute the numbers.

But it's not the data that have me concerned; it's Finkelstein's "advice" to lawmakers in the new ObamaCare world. "Addressing rising health care costs" by "addressing obesity" can be an excuse for higher taxes and a lot of very, very intrusive things when it involves socialized medicine and the White House's focus on "prevention" as a way tackle health care costs. On prevention, here's the President at a speech before the AMA in June (emphasis mine):

Building a health care system that promotes prevention rather than just managing diseases will require all of us to do our part. It will take doctors telling us what risk factors we should avoid and what preventive measures we should pursue. And it will take employers following the example of places like Safeway that is rewarding workers for taking better care of their health while reducing health care costs in the process. ...

Our federal government also has to step up its efforts to advance the cause of healthy living. Five of the costliest illnesses and conditions – cancer, cardiovascular disease, diabetes, lung disease, and strokes – can be prevented. And yet only a fraction of every health care dollar goes to prevention or public health. That is starting to change with an investment we are making in prevention and wellness programs that can help us avoid diseases that harm our health and the health of our economy.

Because ObamaCare involves a lot of socialized costs and (allegedly) benefits, the President's "prevention plan" - as the bolded passages above make clear - focuses on (among other things) a shared responsibility among all Americans to "be healthy" and government efforts to ensure that all Americans live up to their new "healthy responsibilities."

Understanding these facts, studies like the one in Health Affairs have me worried. If America's healthcare costs are socialized (i.e., spread out among all of us evenly, regardless of our health, wealth, or personal desires), and prevention is a key part of managing those costs, and "studies show" that, for example, 10% of our population is found to be submarining that cost-management through their love of Hardee's Monster Thickburgers, then what choice does the government have but to discourage obesity through coercion? Afterall, it'll just be enacting its ObamaCare mandate to "advance the cause of healthy living" and keep healthcare costs in check. Right?

Now, coercion might only be a disincentive, like a "soda tax." That's bad enough, but what if it fails? And do we really want this guy and his buddies in DC deciding what we eat, or drink, or smoke or...?

Such is the slippery slope of socialized healthcare. We pay for your health. Studies show that your "fun" is killing the health cost-curve. Ergo, you must stop having fun. Or else.

Maybe I'm a "typical" wingnut libertarian, but maybe not. And before you decide that, consider the closing passages in the AP article on obesity by a big "prevention advocate" (who just also happens to be a big ObamaCare advocate too):

"Health care costs are dramatically higher for people who are obese and it doesn't have to be that way," said Jeff Levi of the nonprofit Trust for America's Health, who wasn't involved in the new research.

"We have ways of changing behavior and changing those health outcomes so that we don't have to deal with the medical consequences of obesity," added Levi, who advocates community-based programs that promote physical activity and better nutrition.
Is it just me, or does that bolded passage sound just a bit too much like it should come from a Bond villain instead of a "community health advocate"?

UPDATE: I didn't even notice that the "soda tax" article that I linked above actually uses the very line of reasoning that worries me:
At the Centers for Disease Control and Prevention's "Weight of the Nation" conference today, CDC chief Dr. Thomas Freiden said increasing the price of unhealthy foods "would be effective" at combating the nation's obesity problem....

Freiden said he was not endorsing the tax as a member of the administration but was "just presenting the science," according to Ambinder. He also said policies that would reduce the cost of healthy foods would effectively bring down obesity rates.

Obesity-related health spending reaches $147 billion a year, double what it was nearly a decade ago, according to a study published Monday by the journal Health Affairs.

Given that evidence, the argument goes, a soda tax could plausibly pay for health care reform both by raising revenues and bringing down the medical expenses associated with obesity.
Now, replace "fast food" or "red meat" for "soda" and it's pretty easy to see the slippery slope created by the nexus of ObamaCare's prevention and cost-cutting mandates. Disturbing.

UPDATE2: A friend points out another ridiculous aspect of the "ObamaCare v. Obesity" issue: current government policies actually encourage obesity! For example, the US subsidizes the domestic production of "unhealthy" foods and food additives, like high fructose corn syrup, and onerous food regulations discourage the production and sale of "healthier" foods like local produce. (2003 NYT Article on the subject is here; it's by the author of The Omnivore's Dilemma, which is a book on the same subject, although I note that I haven't read it and can't vouch for its overall accuracy/theme.)

So outdated FedGov policies unintentionally make people fat, and instead of ditching those policies (which enjoy overwhelming political support) the FedGov just proposes new taxes on fat people. Government logic and efficiency at its finest - and prime reason for us all to be very suspicious of government "prevention" programs.

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